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Does Coronary Plaque Morphology Matter Beyond Plaque Burden?

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Abstract

Purpose of Review

Imaging of adverse coronary plaque features by coronary computed tomography angiography (CCTA) has advanced greatly and at a fast pace. We aim to describe the evolution, present and future in plaque analysis, and its value in comparison to plaque burden.

Recent Findings

Recently, it has been demonstrated that in addition to plaque burden, quantitative and qualitative assessment of coronary plaque by CCTA can improve the prediction of future major adverse cardiovascular events in diverse coronary artery disease scenarios. The detection of high-risk non-obstructive coronary plaque can lead to higher use of preventive medical therapies such as statins and aspirin, help identify culprit plaque, and differentiate between myocardial infarction types. Even more, over traditional plaque burden, plaque analysis including pericoronary inflammation can potentially be useful tools for tracking disease progression and response to medical therapy.

Summary

The identification of the higher risk phenotypes with plaque burden, plaque characteristics, or ideally both can allow the allocation of targeted therapies and potentially monitor response. Further observational data are now required to investigate these key issues in diverse populations, followed by rigorous randomized controlled trials.

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Authors and Affiliations

  1. Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA

    Daniel Lorenzatti, Pamela Piña, Ibolya Csecs, Aldo L. Schenone, Carlos A. Gongora, Mario J. Garcia & Leandro Slipczuk

  2. Cardiology Division, CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic

    Pamela Piña

  3. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA

    Michael J. Blaha

  4. Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA

    Matthew J. Budoff

  5. BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK

    Michelle C. Williams

  6. Edinburgh Imaging, Queen’s Medical Research Institute University of Edinburgh, Edinburgh, UK

    Michelle C. Williams

  7. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Damini Dey & Daniel S. Berman

  8. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Salim S. Virani

  9. Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan

    Salim S. Virani

  10. Clinical Cardiology, Advanced Cardiac Imaging, CV Atherosclerosis and Lipid Disorder Center, Montefiore Health System, NewYork, USA

    Leandro Slipczuk

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  1. Daniel Lorenzatti
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Correspondence to Leandro Slipczuk.

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Conflict of Interest

S. V. has received research support from the Department of Veterans Affairs, NIH, Tahir, and Jooma Family and Honorarium from American College of Cardiology (Associate Editor for Innovations, acc.org). L. S. has received consulting honorarium from Amgen and Phillips and Grant support from Amgen. D. S. B. and D. D. have received software royalties from Cedars-Sinai Medical Center. D. D. was supported by grants from National Heart, Lung and Blood Institute (1R01HL133616 and 1R01HL148787-01A1). MB has received Grants: NIH, FDA, AHA, Amgen, Novo Nordisk, Bayer, Advisory Board: Amgen, Novartis, Novo Nordisk, Bayer, Roche, 89Bio, Kaleido, Inozyme, Agepha, Consulting: Emocha health, Kowa. MJB has received Grants: NIH, Novo Nordisk, Novartis, Speakers Bureau – Esperion, Amgen. Other authors declare no conflict of interest.

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Lorenzatti, D., Piña, P., Csecs, I. et al. Does Coronary Plaque Morphology Matter Beyond Plaque Burden?. Curr Atheroscler Rep 25, 167–180 (2023). https://doi.org/10.1007/s11883-023-01088-0

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