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Imaging the event-prone coronary artery plaque

  • Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Acute coronary events, the dreaded manifestation of coronary atherosclerosis, remain one of the main contributors to mortality and disability in the developed world. The majority of those events are associated with atherosclerotic plaques-related thrombus formation following an acute disruption, that being rupture or erosion, of an event-prone lesion. These historically termed vulnerable plaques have been the target of numerous benchtop and clinical research endeavors, yet to date without solid results that would allow for early identification and potential treatment. Technological leaps in cardiovascular imaging have provided novel insights into the formation and role of the event-prone plaques. From intracoronary optical coherence tomography that has enhanced our understanding of the pathophysiological mechanisms of plaque disruption, over coronary computed tomography angiography that enables non-invasive serial plaque imaging, and positron emission tomography poised to be rapidly implemented into clinical practice to the budding field of plaque imaging with cardiac magnetic resonance, we summarize the invasive and non-invasive imaging modalities currently available in our armamentarium. Finally, the current status and potential future imaging directions are critically appraised.

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Figure 1

Adapted with permission from Oxford University Press from Ref. 33

Figure 2

Reproduced with permission of Elsevier from Ref. 63

Figure 3
Figure 4

Reproduced with permission of Springer from Ref. 67

Figure 5

Reproduced with permission of Elsevier from Ref. 77

Figure 6
Figure 7

Modified and reproduced under the Creative Commons Attribution License (CC BY) from Ref. 86

Figure 8

Modified and reproduced under the Creative Commons Attribution License (CC BY) from Ripa RS, Kjær A. Imaging Atherosclerosis with Hybrid Positron Emission Tomography/Magnetic Resonance Imaging. Biomed Res Int. 2015; 914516

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Abbreviations

TCFA:

Thin cap fibroatheroma

OCT:

Optical coherence tomography

ESS:

Endothelial shear stress

IVUS:

Intravascular ultrasound

NIRS:

Near-infrared spectroscopy

CCTA:

Coronary computed tomography angiography

ACS:

Acute coronary syndrome

PET:

Positron emission tomography

CMR:

Cardiac magnetic resonance

CAD:

Coronary artery disease

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Disclosure

The authors do not have any personal conflicts of interest to declare. However, the University Hospital Zurich holds a research agreement with GE Healthcare.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Andreas A. Giannopoulos MD, Dominik C. Benz MD, Christoph Gräni MD & Ronny R. Buechel MD

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  1. Andreas A. Giannopoulos MD
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  2. Dominik C. Benz MD
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  3. Christoph Gräni MD
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  4. Ronny R. Buechel MD
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Correspondence to Ronny R. Buechel MD.

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Giannopoulos, A.A., Benz, D.C., Gräni, C. et al. Imaging the event-prone coronary artery plaque. J. Nucl. Cardiol. 26, 141–153 (2019). https://doi.org/10.1007/s12350-017-0982-0

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  • DOI: https://doi.org/10.1007/s12350-017-0982-0

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