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CARDIOLOGY / STATE OF THE ART PAPER
Imaging approaches in risk stratification of patients with coronary artery disease: a narrative review
1
Department of Cardio-Thoracic-Vascular Diseases, IRCCS Foundation Ca’ Granda Hospital Maggiore Polyclinic, Milan, Italy
2
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
3
Cardiology Unit, IRCCS University Hospital of Bologna, Bologna, Italy
4
Department of Medical and Surgical Sciences – DIMEC – Alma Mater Studiorum, University of Bologna, Bologna, Italy
5
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, University of Milan, Milan, Italy
6
Poliambulance Foundation, Department of Cardiothoracic, Brescia, Italy
Submission date: 2024-02-22
Final revision date: 2024-05-01
Acceptance date: 2024-05-16
Online publication date: 2024-06-06
Publication date: 2025-02-28
Corresponding author
Gloria Santangelo
Department of Cardio-Thoracic-Vascular Diseases IRCCS Foundation Ca’ Granda Hospital Maggiore Polyclinic Milan, Italy
Department of Cardio-Thoracic-Vascular Diseases IRCCS Foundation Ca’ Granda Hospital Maggiore Polyclinic Milan, Italy
Arch Med Sci 2025;21(1):16-31
KEYWORDS
TOPICS
ABSTRACT
Coronary artery disease (CAD) is the most common cause of mortality among adults worldwide. In the prognostic risk stratification of these patients, crucial determinants are lumen stenosis, total volume and composition of the plaque. Considering that most of the myocardial infarctions are due to non-obstructive plaques or are associated with high-risk features, plaque composition can serve as an independent predictor of cardiac outcomes. Conversely, although there is a close relationship between ischemia and CAD severity, the assessment of the degree of ischemia, as a surrogate marker of the coronary plaque burden, remains a controversial issue. Thus, aim of this narrative review is to discuss the usefulness of the imaging methodologies to differentiate the ischemia vs the plaque burden in clinical practice. New diagnostic tools to evaluate the extent of the atheromatous coronary artery could help in tailoring a personalized therapeutic approach.
REFERENCES (94)
1.
Brown JC, Gerhardt TE, Kwon E. Risk factors for coronary artery disease. StatPearls, Treasure Island (FL) 2023.
2.
Burke-Kleinman J, Gotlieb AI. Progression of Arterial Vasa Vasorum from Regulator of Arterial Homeostasis to Promoter of Atherogenesis. Am J Pathol 2023; 193: 1468-84.
3.
Nissen SE. Plaque morphology, inflammation, and outcome: cautious and tempered interpretation warranted. Eur Heart J 2023; 44: 3926-8.
4.
Holmstrom L, Juntunen S, Vahatalo J, et al. Plaque histology and myocardial disease in sudden coronary death: the Fingesture study. Eur Heart J 2022; 43: 4923-30.
5.
Mortensen MB, Dzaye O, Steffensen FH, et al. Impact of plaque burden versus stenosis on ischemic events in patients with coronary atherosclerosis. J AmColl Cardiol 2020; 76: 2803-13.
6.
Villines TC, Rodriguez Lozano P. Transitioning from stenosis to plaque burden in the cardiac CT era: the changing risk paradigm. J Am Coll Cardiol 2020; 76: 2814-6.
7.
Newby DE, Williams MC, Dweck MR. Forget ischemia: it’s all about the plaque. Circulation 2021; 144: 1039-41.
8.
Stone PH, Libby P, Boden WE. Fundamental pathobiology of coronary atherosclerosis and clinical implications for chronic ischemic heart disease management – the plaque hypothesis: a narrative review. JAMA Cardiol 2023; 8: 192-201.
9.
Mancini GBJ, Hartigan PM, Shaw LJ, et al. Predicting outcome in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation): coronary anatomy versus ischemia. JACC Cardiovasc Interv 2014; 7: 195-201.
10.
Maron DJ, Hochman JS, Reynolds HR, et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med 2020; 382: 1395-407.
11.
BARI 2D Study Group; Frye RL, August P, Brooks MM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 2009; 360: 2503-15.
12.
Boden WE, Teo KK, Hartigan PM, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356: 1503-16.
13.
Reynolds HR, Shaw LJ, Min JK, et al. Outcomes in the ISCHEMIA trial based on coronary artery disease and ischemia severity. Circulation 2021; 144: 1024-38.
14.
Williams MC, Moss AJ, Dweck M, et al. Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART ctudy. J Am Coll Cardiol 2019; 73: 291-301.
15.
Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 2015; 372: 1291-300.
16.
Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011; 364: 226-35.
17.
Otsuka K, Fukuda S, Tanaka A, et al. Prognosis of vulnerable plaque on computed tomographic coronary angiography with normal myocardial perfusion image. Eur Heart J Cardiovasc Imaging 2014; 15: 332-40.
18.
Stuijfzand WJ, van Rosendael AR, Lin FY, et al. Stress Myocardial perfusion imaging vs coronary computed tomographic angiography for diagnosis of invasive vessel-specific coronary physiology: Predictive Modeling Results From the Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia (CREDENCE) Trial. JAMA Cardiol 2020; 5: 1338-48.
19.
Lee JM, Choi KH, Koo BK, et al. Prognostic implications of plaque characteristics and stenosis severity in patients with coronary artery disease. J Am Coll Cardiol 2019; 73: 2413-24.
20.
Kedhi E, Berta B, Roleder T, et al. Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT-FFR trial. Eur Heart J 2021; 42: 4671-9.
21.
Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41: 407-77.
22.
Carrabba N, Migliorini A, Pradella S, et al. Old and New NICE Guidelines for the evaluation of new onset stable chest pain: a real world perspective. Biomed Res Int 2018; 2018: 3762305.
23.
Neglia D, Rovai D, Caselli C, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging 2015; 8: e002179. doi: 10.1161/CIRCIMAGING.114.002179..
24.
Hoffmann U, Ferencik M, Udelson JE, et al. Prognostic value of noninvasive cardiovascular testing in patients with stable chest pain: insights from the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation 2017; 135: 2320-32.
25.
SCOT-HEART investigators. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label p-g, multicentre trial. Lancet 2015; 385: 2383-91.
26.
van Rosendael SE, Bax AM, Lin FY, et al. Sex and age-specific interactions of coronary atherosclerotic plaque onset and prognosis from coronary computed tomography. Eur Heart J Cardiovasc Imaging 2023; 24: 1180-9.
27.
Mendelsohn ME, Karas RH. Estrogen and the blood vessel wall. Curr Opin Cardiol 1994; 9: 619-626.
28.
Hiteshi AK, Li D, Gao Y, et al. Gender differences in coronary artery diameter are not related to body habitus or left ventricular mass. Clin Cardiol 2014; 37: 605-9.
29.
Yao JQ, Deng ZJ, Fang MX, et al. Expression of serum inflammatory cytokines and oxidative stress markers and their correlation with coronary artery calcium score in patients with coronary heart disease. Arch Med Sci 2023; 19: 1709-13.
30.
Taylor CA, Fonte TA, Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol 2013; 61: 2233-41.
31.
Uzu K, Otake H, Choi G, et al. Lumen boundaries extracted from coronary computed tomography angiography on computed fractional flow reserve (FFRCT): validation with optical coherence tomography. EuroIntervention 2019; 14: e1609-e18. doi: 10.4244/EIJ-D-17-01132.
32.
Celeng C, Leiner T, Maurovich-Horvat P, et al. Anatomical and functional computed tomography for diagnosing hemodynamically significant coronary artery disease: a meta-analysis. JACC Cardiovasc Imaging 2019; 12 (7 Pt 2): 1316-25.
33.
Patel MR, Norgaard BL, Fairbairn TA, et al. 1-Year impact on medical practice and clinical outcomes of FFR(CT): the ADVANCE Registry. JACC Cardiovasc Imaging 2020; 13 (1 Pt 1): 97-105.
34.
Lu M, Wang S, Sirajuddin A, Arai AE, Zhao S. Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: A systematic review and meta-analysis. Int J Cardiol 2018; 258: 325-31.
35.
Hubbard L, Malkasian S, Molloi S. Dynamic CT myocardial perfusion without image registration. Sci Rep 2022; 12: 12608.
36.
Pontone G, Baggiano A, Andreini D, et al. Stress computed tomography perfusion versus fractional flow reserve CT derived in suspected coronary artery disease: the PERFECTION study. JACC Cardiovasc Imaging 2019; 12 (8 Pt 1): 1487-97.
37.
Narula J, Nakano M, Virmani R, et al. Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol 2013; 61: 1041-51.
38.
Gaba P, Gersh BJ, Muller J, Narula J, Stone GW. Evolving concepts of the vulnerable atherosclerotic plaque and the vulnerable patient: implications for patient care and future research. Nat Rev Cardiol 2023; 20: 181-96.
39.
Kolossvary M, Szilveszter B, Merkely B, Maurovich-Horvat P. Plaque imaging with CT-a comprehensive review on coronary CT angiography based risk assessment. Cardiovasc Diagn Ther 2017; 7: 489-506.
40.
Rumberger JA, Kaufman L. A rosetta stone for coronary calcium risk stratification: agatston, volume, and mass scores in 11,490 individuals. AJR Am J Roentgenol 2003; 181: 743-8.
41.
Budoff MJ, Kinninger A, Gransar H, et al. CONFIRM Investigators. When does a calcium score equate to secondary prevention? Insights from the multinational CONFIRM Registry. JACC Cardiovascular Imaging 2023; 16: 1181-9.
42.
Budoff MJ, Mayrhofer T, Ferencik M, et al. Prognostic value of coronary artery calcium in the PROMISE study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation 2017; 136: 1993-2005.
43.
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 2019; 139: e1082-e143.
44.
Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2022; 29: 5-115.
45.
Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study J Am Coll Cardiol 2010; 56: 1397-406.
46.
van den Hoogen IJ, Wang X, Butcher SC, et al. Incorporating coronary artery calcium scoring in the prediction of obstructive coronary artery disease with myocardial ischemia: a study with sequential use of coronary computed tomography angiography and positron emission tomography imaging. J Nucl Cardiol 2023; 30: 178-88.
47.
Mircoli L, Bacà N, Antonelli B, et al. Induced myocardial ischemia in candidates to liver transplantation without evidence of heart disease. Ann Med 2023; 55: 2237521.
48.
Pellikka PA, Arruda-Olson A, Chaudhry FA, et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the american society of echocardiography. J Am Soc Echocardiogr 2020; 33: 1-41.e8.
49.
Gaibazzi N, Rigo F, Lorenzoni V, et al. Comparative prediction of cardiac events by wall motion, wall motion plus coronary flow reserve, or myocardial perfusion analysis: a multicenter study of contrast stress echocardiography. JACC Cardiovasc Imaging 2013; 6: 1-12.
50.
Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG; American Society of Echocardiography. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007; 20: 1021-41.
51.
Picano E, Ciampi Q, Arbucci R, et al. Stress echo 2030: the new ABCDE protocol defining the future of cardiac imaging. Eur Heart J Suppl 2023; 25 (Suppl. C): C63-C7.
52.
Cortigiani L, Bigi R, Sicari R, Landi P, Bovenzi F, Picano E. Prognostic value of pharmacological stress echocardiography in diabetic and nondiabetic patients with known or suspected coronary artery disease. J Am Coll Cardiol 2006; 47: 605-10.
53.
Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000; 343: 1445-53.
54.
Li M, Zhou T, Yang LF, Peng ZH, Ding J, Sun G. Diagnostic accuracy of myocardial magnetic resonance perfusion to diagnose ischemic stenosis with fractional flow reserve as reference: systematic review and meta-analysis. JACC Cardiovasc Imaging 2014; 7: 1098-105.
55.
Takx RA, Blomberg BA, El Aidi H, et al. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging 2015; 8: e002666. doi: 10.1161/CIRCIMAGING.114.002666.
56.
Patel AR, Salerno M, Kwong RY, Singh A, Heydari B, Kramer CM. Stress cardiac magnetic resonance myocardial perfusion imaging: JACC review topic of the week. J Am Coll Cardiol 2021; 78: 1655-68.
57.
Pontone G, Andreini D, Bertella E, et al. Prognostic value of dipyridamole stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a mid-term follow-up study. Eur Radiol 2016; 26: 2155-65.
58.
Seetharam K, Lerakis S. Cardiac magnetic resonance imaging: the future is bright. F1000Res 2019; 8: F1000 Faculty Rev-1636. doi: 10.12688/f1000research.19721.1.
59.
Bateman TM. Advantages and disadvantages of PET and SPECT in a busy clinical practice. J Nucl Cardiol 2012; 19 Suppl. 1: S3-11.
60.
Berman DS, Kang X, Slomka PJ, et al. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol 2007; 14: 521-8.
61.
Dewey M, Siebes M, Kachelriess M, et al. Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia. Nat Rev Cardiol 2020; 17: 427-50.
62.
Sorbets E, Fox KM, Elbez Y, et al. Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry. Eur Heart J 2020; 41: 347-56.
63.
Virani SS, Newby LK, Arnold SV, , et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148: e9-e119.
64.
Kotseva K, De Bacquer D, Jennings C, et al. Time trends in lifestyle, risk factor control, and use of evidence-based medications in patients with coronary heart disease in Europe: results from 3 EUROASPIRE surveys, 1999-2013. Glob Heart 2017; 12: 315-22e3.
65.
Wijeysundera HC, Machado M, Farahati F, et al. Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005. JAMA 2010; 303: 1841-7.
66.
Daly CA, De Stavola B, Sendon JL, et al. Predicting prognosis in stable angina – results from the Euro heart survey of stable angina: prospective observational study. BMJ 2006; 332: 262-7.
67.
Steeds RP, Garbi M, Cardim N, et al. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review. Eur Heart J Cardiovasc Imaging 2017; 18: 1191-204.
68.
Lopes RD, Alexander KP, Stevens SR, et al. Initial invasive versus conservative management of stable ischemic heart disease in patients with a history of heart failure or left ventricular dysfunction: insights from the ISCHEMIA trial. Circulation 2020; 142: 1725-35.
69.
Garzillo CL, Hueb W, Gersh BJ, et al. Long-term analysis of left ventricular ejection fraction in patients with stable multivessel coronary disease undergoing medicine, angioplasty or surgery: 10-year follow-up of the MASS II trial. Eur Heart J 2013; 34: 3370-7.
70.
Park DW, Kang DY, Ahn JM, et al. Routine functional testing or standard care in high-risk patients after PCI. N Engl J Med 2022; 387: 905-15.
71.
Park CS, Park JJ, Oh IY, et al. Relation of renal function with left ventricular systolic function and NT-proBNP level and its prognostic implication in heart failure with preserved versus reduced ejection fraction: an analysis from the Korean Heart Failure (KorHF) Registry. Korean Circ J 2017; 47: 727-41.
72.
Uchida T, Popma J, Stone GW, et al. The clinical impact of routine angiographic follow-up in randomized trials of drug-eluting stents: a critical assessment of “oculostenotic” reintervention in patients with intermediate lesions. JACC Cardiovasc Interv 2010; 3: 403-11.
73.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144: e368-e454.
74.
Motoyama S, Ito H, Sarai M, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 2015; 66: 337-46.
75.
Andreini D, Modolo R, Katagiri Y, et al. Impact of fractional flow reserve derived from coronary computed tomography angiography on heart team treatment decision-making in patients with multivessel coronary artery disease: insights from the SYNTAX III REVOLUTION trial. Circ Cardiovasc Interv 2019; 12: e007607.
76.
Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Circulation 2010; 122: e525-55.
77.
Beller GA. Stress testing after coronary revascularization too much, too soon. J Am Coll Cardiol 2010; 56: 1335-7.
78.
Andreini D, Collet C, Leipsic J, et al. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EuroIntervention 2022; 18: e872-e87.
79.
Narula J, Chandrashekhar Y, Ahmadi A, et al. SCCT 2021 Expert consensus document on coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15: 192-217.
80.
Tamis-Holland JE. Surveillance stress testing “POST-PCI” – a future class III recommendation? N Engl J Med 2022; 387: 941-2.
81.
Banach M, Surma S, Toth PP, endorsed by the International Lipid Expert Panel (ILEP). 2023: The year in cardiovascular disease – the year of new and prospective lipid lowering therapies. Can we render dyslipidemia a rare disease by 2024? Arch Med Sci 2023; 19: 1602-15.
82.
Ferri N, Ruscica M, Fazio S, Corsini A. Low-density lipoprotein cholesterol-lowering drugs: a narrative review. J Clin Med 2024; 13: 943.
83.
Rivera FB, Cha SW, Varona MC, et al. Atherosclerotic coronary plaque regression from lipid-lowering therapies: a meta-analysis and meta-regression. Am J Prev Cardiol 2024; 18: 100645.
84.
Andelius L, Mortensen MB, Norgaard BL, Abdulla J. Impact of statin therapy on coronary plaque burden and composition assessed by coronary computed tomographic angiography: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2018; 19: 850-8.
85.
Park HB, Arsanjani R, Sung JM, et al. Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results from the PARADIGM study. Eur Heart J Cardiovasc Imaging 2023; 24: 1536-43.
86.
Nicholls SJ, Kataoka Y, Nissen SE, et al. Effect of evolocumab on coronary plaque phenotype and burden in statin-treated patients following myocardial infarction. JACC Cardiovasc Imaging 2022; 15: 1308-21.
87.
Raber L, Ueki Y, Otsuka T, et al. Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction: the PACMAN-AMI randomized clinical trial. JAMA 2022; 327: 1771-81.
88.
Ruscica M, Sirtori CR, Carugo S, Calder PC, Corsini A. Omega-3 and cardiovascular prevention – Is this still a choice? Pharmacol Res 2022; 182: 106342.
89.
Budoff MJ, Bhatt DL, Kinninger A, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J 2020; 41: 3925-32.
90.
Ruscica M, Corsini A, Ferri N, Banach M, Sirtori CR. Clinical approach to the inflammatory etiology of cardiovascular diseases. Pharmacol Res 2020; 159: 104916.
91.
Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with chronic coronary disease. N Engl J Med 2020; 383: 1838-47.
92.
Rahoual G, Zeitouni M, Charpentier E, et al. Phenotyping coronary plaque by computed tomography in premature coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25: 257-66.
93.
Ibanez B, Fernandez-Ortiz A, Fernandez-Friera L, Garcia-Lunar I, Andres V, Fuster V. Progression of Early Subclinical Atherosclerosis (PESA) Study: JACC Focus Seminar 7/8. J Am Coll Cardiol 2021; 78: 156-79.
94.
Liu S, Hou J, Wan J, et al. Effect of intensive lipid-lowering therapy on coronary plaque stabilization derived from optical coherence tomography: a meta-analysis and meta-regression. Cardiovasc Drugs Ther 2023. doi: 10.1007/s10557-023-07511-7.
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