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Review
. 2024 Jul 22;13(14):4277.
doi: 10.3390/jcm13144277.

Beyond Stress Ischemia: Unveiling the Multifaceted Nature of Coronary Vulnerable Plaques Using Cardiac Computed Tomography

Gianluigi Napoli  1 , Saima Mushtaq  2 , Paolo Basile  1 , Maria Cristina Carella  1 , Daniele De Feo  1 , Michele Davide Latorre  1 , Andrea Baggiano  2 , Marco Matteo Ciccone  1 , Gianluca Pontone  2   3 , Andrea Igoren Guaricci  1
Affiliations
Review

Beyond Stress Ischemia: Unveiling the Multifaceted Nature of Coronary Vulnerable Plaques Using Cardiac Computed Tomography

Gianluigi Napoli et al. J Clin Med. .

Abstract

Historically, cardiovascular prevention has been predominantly focused on stress-induced ischemia, but recent trials have challenged this paradigm, highlighting the emerging role of vulnerable, non-flow-limiting coronary plaques, leading to a shift towards integrating plaque morphology with functional data into risk prediction models. Coronary computed tomography angiography (CCTA) represents a high-resolution, low-risk, and largely available non-invasive modality for the precise delineation of plaque composition, morphology, and inflammatory activity, further enhancing our ability to stratify high-risk plaque and predict adverse cardiovascular outcomes. Coronary artery calcium (CAC) scoring, derived from CCTA, has emerged as a promising tool for predicting future cardiovascular events in asymptomatic individuals, demonstrating incremental prognostic value beyond traditional cardiovascular risk factors in terms of myocardial infarction, stroke, and all-cause mortality. Additionally, CCTA-derived information on adverse plaque characteristics, geometric characteristics, and hemodynamic forces provides valuable insights into plaque vulnerability and seems promising in guiding revascularization strategies. Additionally, non-invasive assessments of epicardial and pericoronary adipose tissue (PCAT) further refine risk stratification, adding prognostic significance to coronary artery disease (CAD), correlating with plaque development, vulnerability, and rupture. Moreover, CT imaging not only aids in risk stratification but is now emerging as a screening tool able to monitor CAD progression and treatment efficacy over time. Thus, the integration of CAC scoring and PCAT evaluation into risk stratification algorithms, as well as the identification of high-risk plaque morphology and adverse geometric and hemodynamic characteristics, holds promising results for guiding personalized preventive interventions, helping physicians in identifying high-risk individuals earlier, tailoring lifestyle and pharmacological interventions, and improving clinical outcomes in their patients.

Keywords: CCTA; coronary artery calcium; coronary plaque.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Correspondent ICA and IVUS of a patient with LM distal lesion. CFx, circumflex artery; LAD, left anterior descending artery; LM, left main; MLA, minimum lumen area; VA, vessel area.
Figure 2
Figure 2
A case of a 70-year-old male with an HRP on proximal right coronary artery with LAP and positive remodeling. HRP, high-risk plaque; LAP, low-attenuation plaque. (A): Multiplanar reconstruction (MPR) of the coronary vessel. (B,C): axial view of the coronary artery at the level of proximal edge of the stenosis and minimal luminal area (MLA) of the stenosis, respectively.
Figure 3
Figure 3
Distal left main artery plaque in a 53-year-old male with atypical chest pain and normal electrocardiogram. The multiplanar reconstruction image (A) shows a plaque in distal LM with high-risk features (positive remodeling, low attenuation, high plaque volume) (B,C) and positive FFRCT with high delta FFR-CT (D).
See this image and copyright information in PMC

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References

    1. Roth G.A., Mensah G.A., Johnson C.O., Addolorato G., Ammirati E., Baddour L.M., Barengo N.C., Beaton A.Z., Benjamin E.J., Benziger C.P., et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J. Am. Coll. Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010. - DOI - PMC - PubMed
    1. Neglia D., Liga R., Gimelli A., Podlesnikar T., Cvijić M., Pontone G., Miglioranza M.H., Guaricci A.I., Seitun S., Clemente A., et al. Use of cardiac imaging in chronic coronary syndromes: The EURECA Imaging registry. Eur. Heart J. 2022;44:142–158. doi: 10.1093/eurheartj/ehac640. - DOI - PubMed
    1. Gaibazzi N., Porter T., Lorenzoni V., Pontone G., De Santis D., De Rosa A., Guaricci A.I. Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging. J. Am. Heart Assoc. 2017;6:e006202. doi: 10.1161/JAHA.117.006202. - DOI - PMC - PubMed
    1. Hachamovitch R., Hayes S.W., Friedman J.D., Cohen I., Berman D.S. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2900–2907. doi: 10.1161/01.CIR.0000072790.23090.41. - DOI - PubMed
    1. Knuuti J., Wijns W., Saraste A., Capodanno D., Barbato E., Funck-Brentano C., Prescott E., Storey R.F., Deaton C., Cuisset T., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC) Eur. Heart J. 2019;41:407–477. doi: 10.1093/eurheartj/ehz425. - DOI - PubMed

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