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Vulnerable plaques and patients: state-of-the-art

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Title: Vulnerable plaques and patients: state-of-the-art
Authors: Tomaniak, M
Katagiri, Y
Modolo, R
Silva, RD
Khamis, RY
Bourantas, CV
Torii, R
Wentzel, JJ
Gijsen, FJH
Van Soest, G
Stone, PH
West, NEJ
Maehara, A
Lerman, A
Van der Steen, AFW
Lüscher, TF
Virmani, R
Koenig, W
Stone, GW
Muller, JE
Wijns, W
Serruys, PW
Onuma, Y
Item Type: Journal Article
Abstract: Despite advanced understanding of the biology of atherosclerosis, coronary heart disease remains the leading cause of death worldwide. Progress has been challenging as half of the individuals who suffer sudden cardiac death do not experience premonitory symptoms. Furthermore, it is well-recognized that also a plaque that does not cause a haemodynamically significant stenosis can trigger a sudden cardiac event, yet the majority of ruptured or eroded plaques remain clinically silent. In the past 30 years since the term 'vulnerable plaque' was introduced, there have been major advances in the understanding of plaque pathogenesis and pathophysiology, shifting from pursuing features of 'vulnerability' of a specific lesion to the more comprehensive goal of identifying patient 'cardiovascular vulnerability'. It has been also recognized that aside a thin-capped, lipid-rich plaque associated with plaque rupture, acute coronary syndromes (ACS) are also caused by plaque erosion underlying between 25% and 60% of ACS nowadays, by calcified nodule or by functional coronary alterations. While there have been advances in preventive strategies and in pharmacotherapy, with improved agents to reduce cholesterol, thrombosis, and inflammation, events continue to occur in patients receiving optimal medical treatment. Although at present the positive predictive value of imaging precursors of the culprit plaques remains too low for clinical relevance, improving coronary plaque imaging may be instrumental in guiding pharmacotherapy intensity and could facilitate optimal allocation of novel, more aggressive, and costly treatment strategies. Recent technical and diagnostic advances justify continuation of interdisciplinary research efforts to improve cardiovascular prognosis by both systemic and 'local' diagnostics and therapies. The present state-of-the-art document aims to present and critically appraise the latest evidence, developments, and future perspectives in detection, prevention, and treatment of 'high-risk' plaques occurring in 'vulnerable' patients.
Issue Date: 14-Aug-2020
Date of Acceptance: 26-Mar-2020
URI: http://hdl.handle.net/10044/1/81094
DOI: 10.1093/eurheartj/ehaa227
ISSN: 0195-668X
Publisher: European Society of Cardiology
Start Page: 2997
End Page: 3004
Journal / Book Title: European Heart Journal
Volume: 41
Issue: 31
Copyright Statement: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in European Heart Journal following peer review. The definitive publisher-authenticated version is available online at: https://doi.org/10.1093/eurheartj/ehaa227
Sponsor/Funder: British Heart Foundation
Funder's Grant Number: FS/17/16/32560
Keywords: Thin-cap fibroatheroma
Acute coronary syndromes
Cardiovascular pharmacotherapy
Culprit plaque
New invasive coronary imaging modalities
Plaque erosion
Plaque rupture
Vulnerable plaque
Thin-cap fibroatheroma
Acute coronary syndromes
Cardiovascular pharmacotherapy
Culprit plaque
New invasive coronary imaging modalities
Plaque erosion
Plaque rupture
Vulnerable plaque
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: England
Article Number: ARTN ehaa227
Online Publication Date: 2020-05-13
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine