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Vulnerable plaques and patients: state-of-the-art

  • Tomaniak, Mariusz ORCID First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
  • Katagiri, Yuki Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  • Modolo, Rodrigo ORCID Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
  • de Silva, Ranil NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  • Khamis, Ramzi Y National Heart and Lung Institute, Imperial College London, London, UK
  • Bourantas, Christos V Institute of Cardiovascular Sciences, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
  • Torii, Ryo ORCID Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
  • Wentzel, Jolanda J Department of Cardiology, Biomedical Engineering, Erasmus Medical Centre, Rotterdam, The Netherlands
  • Gijsen, Frank J H Department of Biomedical Engineering, Erasmus Medical Centre, Thorax Centre, Rotterdam, The Netherlands
  • van Soest, Gijs ORCID Department of Cardiology, Biomedical Engineering, Erasmus Medical Centre, Rotterdam, The Netherlands
  • Stone, Peter H Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  • West, Nick E J Department of Interventional Cardiology, Royal Papworth Hospital, Papworth Rd, Trumpington, Cambridge CB2 0AY, UK
  • Maehara, Akiko Clinical Trials Centre, Cardiovascular Research Foundation, New York, NY, USA
  • Lerman, Amir ORCID Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
  • van der Steen, Antonius F W ORCID Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
  • Lüscher, Thomas F Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
  • Virmani, Renu CVPath Institute, Gaithersburg, MD 20878, USA
  • Koenig, Wolfgang Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
  • Stone, Gregg W Clinical Trials Centre, Cardiovascular Research Foundation, New York, NY, USA
  • Muller, James E ORCID Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  • Wijns, William Saolta University Healthcare Group, Galway, Ireland
  • Serruys, Patrick W ORCID Department of Cardiology, National University of Ireland, Galway, Ireland
  • Onuma, Yoshinobu Department of Cardiology, National University of Ireland, Galway, Ireland
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  • 2020-5-13
Published in:
  • European Heart Journal. - Oxford University Press (OUP). - 2020, vol. 41, no. 31, p. 2997-3004
Cardiology and Cardiovascular Medicine
English Abstract
Despite advanced understanding of the biology of atherosclerosis, coronary heart disease remains the leading cause of death worldwide. Progress has been challenging as half of the individuals who suffer sudden cardiac death do not experience premonitory symptoms. Furthermore, it is well-recognized that also a plaque that does not cause a haemodynamically significant stenosis can trigger a sudden cardiac event, yet the majority of ruptured or eroded plaques remain clinically silent. In the past 30 years since the term ‘vulnerable plaque’ was introduced, there have been major advances in the understanding of plaque pathogenesis and pathophysiology, shifting from pursuing features of ‘vulnerability’ of a specific lesion to the more comprehensive goal of identifying patient ‘cardiovascular vulnerability’. It has been also recognized that aside a thin-capped, lipid-rich plaque associated with plaque rupture, acute coronary syndromes (ACS) are also caused by plaque erosion underlying between 25% and 60% of ACS nowadays, by calcified nodule or by functional coronary alterations. While there have been advances in preventive strategies and in pharmacotherapy, with improved agents to reduce cholesterol, thrombosis, and inflammation, events continue to occur in patients receiving optimal medical treatment. Although at present the positive predictive value of imaging precursors of the culprit plaques remains too low for clinical relevance, improving coronary plaque imaging may be instrumental in guiding pharmacotherapy intensity and could facilitate optimal allocation of novel, more aggressive, and costly treatment strategies. Recent technical and diagnostic advances justify continuation of interdisciplinary research efforts to improve cardiovascular prognosis by both systemic and ‘local’ diagnostics and therapies. The present state-of-the-art document aims to present and critically appraise the latest evidence, developments, and future perspectives in detection, prevention, and treatment of ‘high-risk’ plaques occurring in ‘vulnerable’ patients.
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  • English
Open access status
green
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https://sonar.ch/global/documents/226761
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