Plaques Do Not Act Alone: Time to Redefine Coronary Vulnerability from Lesion to Phenotype

Area of Science:

• Cardiovascular Medicine
• Biomedical Engineering
• Translational Research

Background:

• Traditional plaque vulnerability assessment based on morphology lacks clinical predictive power.
• Emerging evidence suggests coronary vulnerability is a dynamic phenotype influenced by biology, inflammation, and hemodynamics.
• A shift from static morphological features to a dynamic, patient-specific understanding is crucial.

Purpose of the Study:

• To redefine coronary vulnerability beyond morphological criteria.
• To explore advanced methods for assessing this complex phenotype.
• To establish a framework for improved risk stratification and personalized prevention in coronary artery disease.

Main Methods:

• Utilizing advanced imaging modalities for plaque characterization.
• Applying artificial intelligence for data analysis and pattern recognition.
• Incorporating circulating biomarkers for systemic assessment.
• Integrating multidimensional data for a comprehensive phenotype assessment.

Main Results:

• Demonstrated the limitations of classical plaque morphology in risk prediction.
• Highlighted the dynamic and patient-specific nature of coronary vulnerability.
• Showcased the potential of integrating imaging, AI, and biomarkers for assessment.

Conclusions:

• A multidimensional assessment integrating plaque biology, inflammation, and hemodynamics is essential.
• Advanced technologies enable a more precise characterization of coronary vulnerability.
• This integrative approach promises enhanced risk stratification and personalized prevention for coronary artery disease patients.