Key result
Non-invasive imaging and biomarkers correlate with invasively confirmed vulnerable plaque features and clinical prognosis.
Why the study?
Although invasive imaging modalities are the gold standard for assessing vulnerable coronary atherosclerotic plaques, evidence suggests a potential role for non-invasive methods.
Can non-invasive imaging modalities and circulating biomarkers accurately identify vulnerable coronary atherosclerotic plaques and improve risk stratification in patients with coronary artery disease?
Can non-invasive imaging modalities and circulating biomarkers accurately identify vulnerable coronary atherosclerotic plaques and improve risk stratification in patients with coronary artery disease?
Non-invasive imaging techniques—especially coronary CT angiography with perivascular fat attenuation and radiomics—alongside circulating biomarkers show strong correlation with invasive plaque assessment and hold promise for improving cardiovascular risk stratification.
Answers are grounded in this paper and cite their sources.
Noninvasive plaque imaging may aid CAD risk stratification; leaves open whether integration improves outcomes over current models.
Coronary atherosclerosis is a complex, multistep process that may lead to critical complications upon progression, revolving around plaque disruption through either rupture or erosion. Several high-risk features are associated with plaque vulnerability and may add incremental prognostic information. Although invasive imaging modalities such as optical coherence tomography or intravascular ultrasound are considered to be the gold standard in the assessment of vulnerable coronary atherosclerotic plaques (VCAPs), contemporary evidence suggests a potential role for non-invasive methods in this context. Biomarkers associated with deleterious pathophysiologic pathways, including inflammation and extracellular matrix degradation, have been correlated with VCAP characteristics and adverse prognosis. However, coronary computed tomography (CT) angiography has been the most extensively investigated technique, significantly correlating with invasive method-derived VCAP features. The estimation of perivascular fat attenuation as well as radiomic-based approaches represent additional concepts that may add incremental information. Cardiac magnetic resonance imaging (MRI) has also been evaluated in clinical studies, with promising results through the various image sequences that have been tested. As far as nuclear cardiology is concerned, the implementation of positron emission tomography in the VCAP assessment currently faces several limitations with the myocardial uptake of the radiotracer in cases of fluorodeoxyglucose use, as well as with motion correction. Moreover, the search for the ideal radiotracer and the most adequate combination (CT or MRI) is still ongoing. With a look to the future, the possible combination of imaging and circulating inflammatory and extracellular matrix degradation biomarkers in diagnostic and prognostic algorithms may represent the essential next step for the assessment of high-risk individuals.
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Theofilis et al. (2022) conducted a review in Vulnerable coronary atherosclerotic plaques (VCAPs). Non-invasive modalities (coronary CT angiography, perivascular fat attenuation index, radiomics, cardiac MRI, PET, and circulating biomarkers) vs. Invasive imaging modalities (optical coherence tomography or intravascular ultrasound) was evaluated. Non-invasive modalities, particularly coronary CT angiography, perivascular fat attenuation, radiomics, cardiac MRI, and biomarkers, correlate with invasive vulnerable plaque features and prognosis.
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