Elsevier

JACC: Cardiovascular Imaging

Volume 5, Issue 9, September 2012, Pages 941-955
JACC: Cardiovascular Imaging

State-of-the-Art Paper
Detection of High-Risk Atherosclerotic Plaque: Report of the NHLBI Working Group on Current Status and Future Directions

https://doi.org/10.1016/j.jcmg.2012.07.007Get rights and content
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The leading cause of major morbidity and mortality in most countries around the world is atherosclerotic cardiovascular disease, most commonly caused by thrombotic occlusion of a high-risk coronary plaque resulting in myocardial infarction or cardiac death, or embolization from a high-risk carotid plaque resulting in stroke. The lesions prone to result in such clinical events are termed vulnerable or high-risk plaques, and their identification may lead to the development of pharmacological and mechanical intervention strategies to prevent such events. Autopsy studies from patients dying of acute myocardial infarction or sudden death have shown that such events typically arise from specific types of atherosclerotic plaques, most commonly the thin-cap fibroatheroma. However, the search in human beings for vulnerable plaques before their becoming symptomatic has been elusive. Recently, the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study demonstrated that coronary plaques that are likely to cause future cardiac events, regardless of angiographic severity, are characterized by large plaque burden and small lumen area and/or are thin-cap fibroatheromas verified by radiofrequency intravascular ultrasound imaging. This study opened the door to identifying additional invasive and noninvasive imaging modalities that may improve detection of high-risk atherosclerotic lesions and patients. Beyond classic risk factors, novel biomarkers and genetic profiling may identify those patients in whom noninvasive imaging for vulnerable plaque screening, followed by invasive imaging for risk confirmation is warranted, and in whom future pharmacological and/or device-based focal or regional therapies may be applied to improve long-term prognosis.

Key Words

cardiovascular event
high-risk plaque
imaging
prognosis
vulnerable plaque

Abbreviations and Acronyms

ACS
acute coronary syndrome
CAD
coronary artery disease
CT
computed tomography
CTA
computed tomography angiography
FDG
fluorodeoxyglucose
HR
hazard ratio
IPH
intraplaque hemorrhage
IVUS
intravascular ultrasound
LAP
low-attenuation plaque
LCP
lipid core plaque
MACE
major adverse cardiac event(s)
MI
myocardial infarction
MRI
magnetic resonance imaging
NIRS
near-infrared spectroscopy
OCT
optical coherence tomography
PCI
percutaneous coronary intervention
PET
positron emission tomography
PVR
positive vascular remodeling
RF
radiofrequency
TCFA
thin-cap fibroatheroma

Cited by (0)

Dr. Stone has been a consultant to InfraReDx, Boston Scientific, Abbott Vascular, Medtronic, and Volcano. Dr. Sabatine has received research grant support (>$25,000) through Brigham and Women’s Hospital from Abbott Laboratories, Amgen, AstraZeneca, BRAHMS, Bristol-Myers Squibb/Sanofi-Aventis Joint Venture, Critical Diagnostics, Daiichi-Sankyo, Merck, Roche Diagnostics, and Takeda; has served on the scientific advisory board (<$10,000) for Bristol-Myers Squibb/Sanofi-Aventis Joint Venture, GlaxoSmithKline, Merck, and Pfizer; and (>$10,000) Sanofi-Aventis; and has received research support (>$25,000) from Nanosphere. Dr. Tearney has been a consultant to Samsung and Merck; has performed sponsored research for Terumo Corporation; and has the right to receive royalties from Terumo Corporation and MIT. Dr. Narula serves on the advisory boards of GE, Philips, and Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. H. William Strauss, MD, served as Guest Editor for this paper.