Guidelines Clinical Practice
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Cardiol. Jul 26, 2011; 3(7): 219-229
Published online Jul 26, 2011. doi: 10.4330/wjc.v3.i7.219
Non-invasive detection of vulnerable coronary plaque
Faisal Sharif, Derek G Lohan, William Wijns
Faisal Sharif, Department of Cardiology, Regional Hospital Galway, and Regenerative Medicine Institute, National University of Ireland Galway, County Galway, Ireland
Derek G Lohan, Department of Radiology, Regional Hospital Galway, County Galway, Ireland
William Wijns, Department of Cardiology, Cardiovascular Centre, OLV Ziekenhuis, Aalst, 9300, Belgium
Author contributions: All authors contributed equally to the paper.
Correspondence to: Dr. Faisal Sharif, Senior Lecturer Regenerative Medicine/Consultant Cardiologist, Department of Cardiology, Regional Hospital Galway, and Regenerative Medicine Institute, National University of Ireland Galway, County Galway, Ireland. faisal.sharif@nuigalway.ie
Telephone: +353-91-542186 Fax: +353-91-527197
Received: March 28, 2011
Revised: June 16, 2011
Accepted: June 23, 2011
Published online: July 26, 2011
Abstract

Critical coronary stenoses have been shown to contribute to only a minority of acute coronary syndromes and sudden cardiac death. Autopsy studies have identified a subgroup of high-risk patients with disrupted vulnerable plaque and modest stenosis. Consequently, a clinical need exists to develop methods to identify these plaques prospectively before disruption and clinical expression of disease. Recent advances in invasive and non-invasive imaging techniques have shown the potential to identify these high-risk plaques. Non-invasive imaging with magnetic resonance imaging, computed tomography and positron emission tomography holds the potential to differentiate between low- and high-risk plaques. There have been significant technological advances in non-invasive imaging modalities, and the aim is to achieve a diagnostic sensitivity for these technologies similar to that of the invasive modalities. Molecular imaging with the use of novel targeted nanoparticles may help in detecting high-risk plaques that will ultimately cause acute myocardial infarction. Moreover, nanoparticle-based imaging may even provide non-invasive treatments for these plaques. However, at present none of these imaging modalities are able to detect vulnerable plaque nor have they been shown to definitively predict outcome. Further trials are needed to provide more information regarding the natural history of high-risk but non-flow-limiting plaque to establish patient specific targeted therapy and to refine plaque stabilizing strategies in the future.

Keywords: Atherosclerotic plaque; Magnetic resonance imaging; Multidetector row computed tomography; Single photon emission computed tomography