Noninvasive diagnosis of vulnerable coronary plaque

Abstract

Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease. For this reason, screening of asymptomatic coronary atherosclerosis has become an attractive field of research in cardiovascular medicine. Necropsy studies have described histopathological changes associated with the development of acute coronary events. In this regard, thin-cap fibroatheroma has been identified as the main vulnerable coronary plaque feature. Hence, many imaging techniques, such as coronary computed tomography, cardiac magnetic resonance or positron emission tomography, have tried to detect noninvasively these histomorphological characteristics with different approaches. In this article, we review the role of these diagnostic tools in the detection of vulnerable coronary plaque with particular interest in their advantages and limitations as well as the clinical implications of the derived findings.

Keywords: Atherosclerosis; Vulnerable coronary plaque; Diagnosis; Cardiac computed tomography; Cardiac magnetic resonance

Core tip: Noninvasive diagnosis of vulnerable coronary plaque has become of major interest in preventive cardiology. Certain histological features have been related with an increased risk of plaque rupture. Coronary computed tomography has been largely used for this aim, and some lesion characteristics have been consistently associated with acute coronary syndrome in several studies. Moreover, a growing body of evidence suggests the potential role of cardiac magnetic resonance and positron emission tomography in high-risk lesion detection. These promising results should be put in perspective to select the high-risk population that may benefit the most from the use of coronary vulnerable plaque imaging screening.