Imaging of vulnerable plaques: Will it affect patient management and influence outcomes?

Excerpt

Significant advances have been made in the ability to image atherosclerotic plaques in multiple vascular beds in both animal models and in patients.1 Imaging of atherosclerosis in asymptomatic adults by identifying presence of coronary artery calcification (CAC) in plaques with CT scanning is already an accepted technology that received a Class IIa recommendation in the guidelines published by the American College of Cardiology and the American Heart Association.2 Evidence from a large number of subjects shows that the greater the extent of CAC, the higher the future cardiac event rate.3 Those subjects with a zero CAC score have an excellent outcome out to 10-12 years after imaging.4 The EISNER Trial showed that patients who are given results of their CAC score are more likely to modify their CAD risk factors and lower their LDL-cholesterol and blood pressure to a greater degree than patients randomized to a “No Scan” strategy.5 Coronary CT angiography (CCTA) can not only identify flow limiting coronary artery stenoses but also detect plaques with characteristics of vulnerability that are associated with an increase risk of acute coronary syndromes.1,6 These features include positive vessel remodeling, low attenuation plaques (<30 HU) and spotty calcification. …