Clinical Significance of Non-invasive Magnetic Resonance Imaging to Identify High-risk Coronary Plaques as Potential Biomarkers for Preemptive Medicine

Abstract

─ 278 ─ Cardiovascular diseases (CVDs) account for > 17 million deaths globally each year (30% of all deaths), and the number is expected to grow to 23.6 million by 2030. Among CVDs, coronary artery disease (CAD) is the most prevalent.1) In around 50%of cases, sudden cardiac death (SCD) is the first manifestation of heart disease, 2) and CAD underlies 80% of SCDs. In this review, we will discuss the potential of MRI for screening and managing coronary atherosclerosis. I. Magnetic resonance imaging for atherosclerotic plaquesAtherosclerotic plaque characterization by MRI is based on the signal intensity and morphologic appearance of plaques in multiple contrast weightings. MRI detects electromagnetic signals at radio wavelengths emitted by protons in a strong magnetic field. In clinical practice, MRI mainly visualizes signals from Clinical Significance of Non-invasive Magnetic Resonance Imaging to Identify High-risk Coronary Plaques as Potential Biomarkers for Preemptive MedicineYasuhide Asaumi, Teruo Noguchi, Satoshi YasudaIdentification of high-risk coronary plaques is important for management of patients with coronary artery disease (CAD) to prevent future cardiovascular events including death, heart failure, and fatal myocardial infarction. Many studies have described the characteristics of coronary plaques and their clinical outcomes, based on invasive intravascular coronary imaging. Recent technical advancements in multi-slice computed tomography, positron emission tomography, and magnetic resonance imaging (MRI) provide methods for less invasive detection of high-risk coronary atherosclerosis. Our research has focused on understanding the development of coronary atherosclerosis and its clinical outcomes using non-contrast T1-weighted MRI (T1WI), which is non-invasive and does not require the use of ionizing radiation or iodide contrast medium. We have shown that coronary high-intensity plaques (HIPs) detected by non-contrast T1WI are associated with high clinical risk, and therefore might have potential applications in monitoring pharmacological interventions and advancing preemptive medicine in CAD patients. However, the histopathological and molecular mechanisms underlying coronary HIPs remain undetermined. Future studies using a combination of multi-modality images and molecular analysis may facilitate an improved understanding of the molecular dynamics of coronary HIPs.