Imaging the event-prone coronary artery plaque.

Area of Science:

• Cardiology
• Medical Imaging
• Atherosclerosis Research

Background:

• Acute coronary events are a leading cause of mortality, primarily due to thrombus formation on disrupted atherosclerotic plaques.
• Vulnerable plaques, prone to rupture or erosion, are implicated but difficult to identify early.
• Existing research has not yielded reliable methods for early vulnerable plaque detection and treatment.

Purpose of the Study:

• To review current invasive and non-invasive cardiovascular imaging modalities for plaque assessment.
• To discuss technological advancements providing novel insights into plaque formation and disruption.
• To critically appraise the present status and future directions of plaque imaging.

Main Methods:

• Review of intracoronary optical coherence tomography (OCT) for pathophysiological insights.
• Evaluation of coronary computed tomography angiography (CCTA) for non-invasive serial plaque imaging.
• Assessment of positron emission tomography (PET) and cardiac magnetic resonance (CMR) for plaque imaging.

Main Results:

• Cardiovascular imaging technologies have significantly advanced the understanding of vulnerable plaques.
• OCT provides detailed insights into plaque rupture mechanisms.
• CCTA allows for non-invasive monitoring, while PET and CMR show promise for clinical implementation.

Conclusions:

• Technological advancements in cardiovascular imaging are crucial for understanding and potentially managing vulnerable plaques.
• A comprehensive armamentarium of invasive and non-invasive techniques is available for plaque imaging.
• Future directions in plaque imaging hold promise for improved early identification and treatment strategies for acute coronary events.