Vince
Super Moderator
Vulnerable Plaque Detection: An Unrealistic Quest or a Feasible Objective With a Clinical Value?
Christos V Bourantas; Hector M Garcia-Garcia; Ryo Torii; Yao-Jun Zhang; Mark Westwood; Tom Crake; Patrick W Serruys
Heart. 2016;102(8):581-589.
Abstract and Introduction
Abstract
Evidence from the first prospective studies of coronary atherosclerosis demonstrated that intravascular imaging has limited accuracy in detecting lesions that are likely to progress and cause future events, and divided the scientific community into experts who advocate abandoning this quest and others who suggest intensifying our efforts improve and optimise the available imaging techniques. Although the current evidence may not justify the use of invasive or non-invasive imaging in the clinical setting for the detection of vulnerable, high-risk lesions, it is apparent that imaging has provided unique insights about plaque pathophysiology and evolution. Recent evidence indicates that both invasive and non-invasive imaging also provides useful prognostic information in patients with established coronary artery disease and in asymptomatic individuals and is likely to enable more accurate risk stratification. Future studies are anticipated to provide further insights about the value of novel hybrid imaging techniques, which are expected to enable complete assessment of plaque pathophysiology, in detecting vulnerable lesions and identifying high-risk patients that would benefit from new aggressive treatments targeting coronary atherosclerosis.
Introduction
The advances in the treatment of patients with ischaemic heart disease (IHD) have reduced mortality and improved their quality of life. However, the number of patients suffering and dying from IHD has increased in the recent years, and today IHD constitutes the leading cause of death worldwide. This paradox, which can be attributed to lifestyle changes and the increased life expectancy, underscores the need to develop effective prevention strategies that will reduce the incidence of IHD. The clinical scores, however, developed to predict outcomes had a low accuracy in detecting high-risk individuals; therefore, efforts have been made over the recent years to understand the mechanisms regulating plaque growth, to stratify more accurately risk and predict lesions that will cause events.
The in vivo assessment of plaque morphology became feasible in the beginning of the 1990s with the development of intravascular ultrasound (IVUS) that enabled identification of plaque characteristics associated with increased vulnerability. The first, small-scale IVUS studies provided promise that intravascular imaging can detect plaques that are prone to progress and cause events. However, the recently published results of prospective, large-scale, invasive imaging-based studies of coronary atherosclerosis raised concerns about the value of invasive imaging to predict lesions that will progress and cause events, and divided the scientific community.
Today, a considerable number of researchers express their scepticism about the value of imaging to detect vulnerable lesions and argue that we should shift our focus to more realistic targets such as the accurate risk stratification and the identification of high-risk patients; while others advocate that the in vivo imaging of plaque pathology has provided unique insights about plaque growth and suggest that the improvement of the available imaging techniques and the design of hybrid modalities would allow more detailed and accurate assessment of plaque pathophysiology. In this article, we review the current evidence stemming from invasive and non-invasive-based imaging studies of coronary atherosclerosis, present the arguments raised by both opponents and discuss the future role of imaging in the study of atherosclerosis.
Christos V Bourantas; Hector M Garcia-Garcia; Ryo Torii; Yao-Jun Zhang; Mark Westwood; Tom Crake; Patrick W Serruys
Heart. 2016;102(8):581-589.
Abstract and Introduction
Abstract
Evidence from the first prospective studies of coronary atherosclerosis demonstrated that intravascular imaging has limited accuracy in detecting lesions that are likely to progress and cause future events, and divided the scientific community into experts who advocate abandoning this quest and others who suggest intensifying our efforts improve and optimise the available imaging techniques. Although the current evidence may not justify the use of invasive or non-invasive imaging in the clinical setting for the detection of vulnerable, high-risk lesions, it is apparent that imaging has provided unique insights about plaque pathophysiology and evolution. Recent evidence indicates that both invasive and non-invasive imaging also provides useful prognostic information in patients with established coronary artery disease and in asymptomatic individuals and is likely to enable more accurate risk stratification. Future studies are anticipated to provide further insights about the value of novel hybrid imaging techniques, which are expected to enable complete assessment of plaque pathophysiology, in detecting vulnerable lesions and identifying high-risk patients that would benefit from new aggressive treatments targeting coronary atherosclerosis.
Introduction
The advances in the treatment of patients with ischaemic heart disease (IHD) have reduced mortality and improved their quality of life. However, the number of patients suffering and dying from IHD has increased in the recent years, and today IHD constitutes the leading cause of death worldwide. This paradox, which can be attributed to lifestyle changes and the increased life expectancy, underscores the need to develop effective prevention strategies that will reduce the incidence of IHD. The clinical scores, however, developed to predict outcomes had a low accuracy in detecting high-risk individuals; therefore, efforts have been made over the recent years to understand the mechanisms regulating plaque growth, to stratify more accurately risk and predict lesions that will cause events.
The in vivo assessment of plaque morphology became feasible in the beginning of the 1990s with the development of intravascular ultrasound (IVUS) that enabled identification of plaque characteristics associated with increased vulnerability. The first, small-scale IVUS studies provided promise that intravascular imaging can detect plaques that are prone to progress and cause events. However, the recently published results of prospective, large-scale, invasive imaging-based studies of coronary atherosclerosis raised concerns about the value of invasive imaging to predict lesions that will progress and cause events, and divided the scientific community.
Today, a considerable number of researchers express their scepticism about the value of imaging to detect vulnerable lesions and argue that we should shift our focus to more realistic targets such as the accurate risk stratification and the identification of high-risk patients; while others advocate that the in vivo imaging of plaque pathology has provided unique insights about plaque growth and suggest that the improvement of the available imaging techniques and the design of hybrid modalities would allow more detailed and accurate assessment of plaque pathophysiology. In this article, we review the current evidence stemming from invasive and non-invasive-based imaging studies of coronary atherosclerosis, present the arguments raised by both opponents and discuss the future role of imaging in the study of atherosclerosis.
| [/TD] |
