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Imaging of High-Risk Atherosclerotic Plaques

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Atlas of Cardiovascular Computed Tomography
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Abstract

Coronary heart disease causes approximately one of seven deaths in the United States. In 2013, more than 370,000 Americans died of coronary heart disease. Each year, 660,000 Americans have a new coronary event, defined as first myocardial infarction or coronary heart disease death; 300,000 Americans have a recurrent attack and 160,000 have silent myocardial infarctions each year [1].

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References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.

    Article  PubMed  Google Scholar 

  2. Kaul S, Narula J. In search of the vulnerable plaque: is there any light at the end of the catheter? J Am Coll Cardiol. 2014;64:2519–24.

    Article  PubMed  Google Scholar 

  3. Narula J, Nakano M, Virmani R, Kolodgie FD, Petersen R, Newcomb R, et al. Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol. 2013;61:1041–51.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54:49–57.

    Article  PubMed  Google Scholar 

  5. Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol. 2015;66:337–46.

    Article  PubMed  Google Scholar 

  6. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364:226–35.

    Article  PubMed  CAS  Google Scholar 

  7. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319–26.

    Article  PubMed  Google Scholar 

  8. Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J. 2013;34:719–28.

    Article  PubMed  CAS  Google Scholar 

  9. Narula J, Finn AV, Demaria AN. Picking plaques that pop. J Am Coll Cardiol. 2005;45:1970–3.

    Article  PubMed  Google Scholar 

  10. Takaya N, Yuan C, Chu B, Saam T, Polissar NL, Jarvik GP, et al. Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation. 2005;111:2768–75.

    Article  PubMed  Google Scholar 

  11. Dunphy MP, Freiman A, Larson SM, Strauss HW. Association of vascular 18F-FDG uptake with vascular calcification. J Nucl Med. 2005;46:1278–84.

    PubMed  Google Scholar 

  12. Jang IK, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, et al. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation. 2005;111:1551–5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Little WC, Constantinescu M, Applegate RJ, Kutcher MA, Burrows MT, Kahl FR, et al. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation. 1988;78:1157–66.

    Article  CAS  PubMed  Google Scholar 

  14. Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med. 2003;349:2316–25.

    Article  CAS  PubMed  Google Scholar 

  15. Virmani R, Kolodgie FD, Burke AP, Finn AV, Gold HK, Tulenko TN, et al. Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arterioscler Thromb Vasc Biol. 2005;25:2054–61.

    Article  CAS  PubMed  Google Scholar 

  16. Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, et al. Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol. 2004;43:842–7.

    Article  PubMed  Google Scholar 

  17. Maurovich-Horvat P, Hoffmann U, Vorpahl M, Nakano M, Virmani R, Alkadhi H. The napkin-ring sign: CT signature of high-risk coronary plaques? JACC Cardiovasc Imaging. 2010;3:440–4.

    Article  PubMed  Google Scholar 

  18. Ahmadi A, Narula J. Primary and secondary prevention, or subclinical and clinical atherosclerosis. JACC Cardiovasc Imaging. 2017;10(4):447–50.

    Article  PubMed  Google Scholar 

  19. Ambrose JA, Tannenbaum MA, Alexopoulos D, Hjemdahl-Monsen CE, Leavy J, Weiss M, et al. Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol. 1988;12:56–62.

    Article  CAS  PubMed  Google Scholar 

  20. Dacanay S, Kennedy HL, Uretz E, Parrillo JE, Klein LW. Morphological and quantitative angiographic analyses of progression of coronary stenoses. A comparison of Q-wave and non-Q-wave myocardial infarction. Circulation. 1994;90:1739–46.

    Article  PubMed  CAS  Google Scholar 

  21. Hackett D, Verwilghen J, Davies G, Maseri A. Coronary stenoses before and after acute myocardial infarction. Am J Cardiol. 1989;63:1517–8.

    Article  PubMed  CAS  Google Scholar 

  22. Manoharan G, Ntalianis A, Muller O, Hamilos M, Sarno G, Melikian N, et al. Severity of coronary arterial stenoses responsible for acute coronary syndromes. Am J Cardiol. 2009;103:1183–8.

    Article  PubMed  Google Scholar 

  23. Chan KH, Chawantanpipat C, Gattorna T, Chantadansuwan T, Kirby A, Madden A, et al. The relationship between coronary stenosis severity and compression type coronary artery movement in acute myocardial infarction. Am Heart J. 2010;159:584–92.

    Article  PubMed  Google Scholar 

  24. Ahmadi A, Leipsic J, Blankstein R, Taylor C, Hecht H, Stone GW, et al. Do plaques rapidly progress prior to myocardial infarction? The interplay between plaque vulnerability and progression. Circ Res. 2015;117:99–104.

    Article  PubMed  CAS  Google Scholar 

  25. Little WC, Cheng CP, Peterson T, Vinten-Johansen J. Response of the left ventricular end-systolic pressure-volume relation in conscious dogs to a wide range of contractile states. Circulation. 1988;78:736–45.

    Article  PubMed  CAS  Google Scholar 

  26. Zaman T, Agarwal S, Anabtawi AG, Patel NS, Ellis SG, Tuzcu EM, et al. Angiographic lesion severity and subsequent myocardial infarction. Am J Cardiol. 2012;110:167–72.

    Article  PubMed  Google Scholar 

  27. Ojio S, Takatsu H, Tanaka T, Ueno K, Yokoya K, Matsubara T, et al. Considerable time from the onset of plaque rupture and/or thrombi until the onset of acute myocardial infarction in humans: coronary angiographic findings within 1 week before the onset of infarction. Circulation. 2000;102:2063–9.

    Article  PubMed  CAS  Google Scholar 

  28. Otsuka K, Fukuda S, Tanaka A, Nakanishi K, Taguchi H, Yoshikawa J, et al. Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. JACC Cardiovasc Imaging. 2013;6:448–57.

    Article  PubMed  Google Scholar 

  29. Gould KL, Lipscomb K, Calvert C. Compensatory changes of the distal coronary vascular bed during progressive coronary constriction. Circulation. 1975;51:1085–94.

    Article  PubMed  CAS  Google Scholar 

  30. Ahmadi A, Stone GW, Leipsic J, Serruys PW, Shaw L, Hecht H, et al. Association of coronary stenosis and plaque morphology with fractional flow reserve and outcomes. JAMA Cardiol. 2016;1(3):350–7.

    Article  PubMed  Google Scholar 

  31. Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010;55:173–85.

    Article  PubMed  Google Scholar 

  32. Ahmadi A, Kini A, Narula J. Discordance between ischemia and stenosis, or PINSS and NIPSS: are we ready for new vocabulary? JACC Cardiovasc Imaging. 2015;8:111–4.

    Article  PubMed  Google Scholar 

  33. Gaur S, Ovrehus KA, Dey D, Leipsic J, Bøtker HE, Jensen JM, et al. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions. Eur Heart J. 2016;37(15):1220–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Park HB, Heo R, ó Hartaigh B, Cho I, Gransar H, Nakazato R, et al. Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional flow reserve. JACC Cardiovasc Imaging. 2015;8:1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.

    Article  CAS  PubMed  Google Scholar 

  36. Spaan JA, Piek JJ, Hoffman JI, Siebes M. Physiological basis of clinically used coronary hemodynamic indices. Circulation. 2006;113:446–55.

    Article  PubMed  Google Scholar 

  37. Ahmadi A, Stone GW, Leipsic J, Shaw LJ, Villines TC, Kern MJ, et al. Prognostic determinants of coronary atherosclerosis in stable ischemic heart disease: anatomy, physiology, or morphology? Circ Res. 2016;119:317–29.

    Article  CAS  PubMed  Google Scholar 

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Ahmadi, A., Sakakura, K., Yahagi, K., Virmani, R., Narula, J. (2018). Imaging of High-Risk Atherosclerotic Plaques. In: Budoff, M., Achenbach, S., Hecht, H., Narula, J. (eds) Atlas of Cardiovascular Computed Tomography. Springer, London. https://doi.org/10.1007/978-1-4471-7357-1_6

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  • DOI: https://doi.org/10.1007/978-1-4471-7357-1_6

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