The Myth of the “Vulnerable Plaque”

Arbab‐Zadeh, Armin; Fuster, Valentín

doi:10.1016/j.jacc.2014.11.041

Cited by 364 publications

(140 citation statements)

References 90 publications

(101 reference statements)

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“…However, current practice guidelines in Europe and US continue to define CAD according to anatomic criteria [75–77]. This is reasonable because there is a large body of evidence demonstrating high risk of adverse events in patients with obstructive CAD – regardless if the disease is associated with hemodynamic alterations or not [78;79]. Increasing the threshold for the diagnosis of CAD to including hemodynamically significant CAD, e.g., using FFR, would leave many patients with obstructive CAD without a diagnosis of CAD and thus, without current endorsement for important preventative measures.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Rahsepar

Arbab‐Zadeh

2015

Curr Cardiovasc Imaging Rep

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Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many healthcare systems relied on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows to noninvasively visualize coronary artery disease, challenging the role of stress testing as the default noninvasive imaging tool for evaluating patients with chest pain. In this review, we summarize current data on the clinical utility of cardiac computed tomography and stress testing in stable patients with suspected coronary artery disease.

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Section: Discussion and Recommendationsmentioning

confidence: 99%

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Rahsepar

Arbab‐Zadeh

2015

Curr Cardiovasc Imaging Rep

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“…Lastly, although IVUS was shown to be able to predict future events, its positive predictive value was quite low, 18.2% in PROSPECT and 41% in PREDICTION. As expected, these findings raised concerns about the role of imaging in detecting vulnerable lesions and created pessimism in the scientific community about the clinical potential of intravascular imaging to stratify cardiovascular risk [33,34].…”

Section: Intravascular Ultrasoundmentioning

confidence: 79%

Invasive or non-invasive imaging for detecting high-risk coronary lesions?

Patel

Tarkin

Serruys

et al. 2017

Expert Review of Cardiovascular Therapy

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Introduction: Advances in our understanding about atherosclerotic evolution have enabled us to identify specific plaque characteristics that are associated with coronary plaque vulnerability and cardiovascular events. With constant improvements in signal and image processing an arsenal of invasive and non-invasive imaging modalities have been developed that are capable of identifying these features allowing in vivo assessment of plaque vulnerability. Areas covered: This review article presents the available and emerging imaging modalities introduced to assess plaque morphology and biology, describes the evidence from the first large scale studies that evaluated the efficacy of invasive and non-invasive imaging in detecting lesions that are likely to progress and cause cardiovascular events and discusses the potential implications of the in vivo assessment of coronary artery pathology in the clinical setting. Expert commentary: Invasive imaging, with its high resolution, and in particular hybrid intravascular imaging appears as the ideal approach to study the mechanisms regulating atherosclerotic disease progression; whereas non-invasive imaging is expected to enable complete assessment of coronary tree pathology, detection of high-risk lesions, more accurate risk stratification and thus to allow a personalized treatment of vulnerable patients. ARTICLE HISTORY

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“…However, focusing on culprit lesions has resulted in poor predictive value, and recent insights suggest that our attention should rather be on the total atherosclerotic disease burden (3). In this setting, radiotracers might be attractive candidates to assess the degree and extent of atherosclerosis as a systemic disease and eventually monitor therapeutic response.…”

Section: Discussionmentioning

confidence: 99%

“…A large subset of such plaques continues to grow until they cause myocardial ischemia, leading to angina pectoris. Moreover, an emerging paradigm focusing on superficial plaque erosion, departing from the classical thrombotic rupture has been suggested (3–5). Clinical practice relies on detecting ischemia of obstructive lesions to diagnose risk, leaving features like plaque burden and outward remodeling underappreciated (6).…”

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confidence: 99%

PET/MR Imaging of Malondialdehyde-Acetaldehyde Epitopes With a Human Antibody Detects Clinically Relevant Atherothrombosis

Senders

Que

Cho

et al. 2018

Journal of the American College of Cardiology

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BACKGROUND Oxidation-specific epitopes (OSEs) are proinflammatory, and elevated levels in plasma predict cardiovascular events. OBJECTIVES The purpose of this study was to develop novel positron emission tomography (PET) probes to noninvasively image OSE-rich lesions. METHODS An antigen-binding fragment (Fab) antibody library was constructed from human fetal cord blood. After multiple rounds of screening against malondialdehyde-acetaldehyde (MAA) epitopes, the Fab LA25 containing minimal nontemplated insertions in the CDR3 region was identified and characterized. In mice, pharmacokinetics, biodistribution, and plaque specificity studies were performed with Zirconium-89 (89Zr)-labeled LA25. In rabbits, 89Zr-LA25 was used in combination with an integrated clinical PET/magnetic resonance (MR) system. 18F-fluorodeoxyglucose PET and dynamic contrast-enhanced MR imaging were used to evaluate vessel wall inflammation and plaque neovascularization, respectively. Extensive ex vivo validation was carried out through a combination of gamma counting, near infrared fluorescence, autoradiography, immunohistochemistry, and immunofluorescence. RESULTS LA25 bound specifically to MAA epitopes in advanced and ruptured human atherosclerotic plaques with accompanying thrombi and in debris from distal protection devices. PET/MR imaging 24 h after injection of 89Zr-LA25 showed increased uptake in the abdominal aorta of atherosclerotic rabbits compared with nonatherosclerotic control rabbits, confirmed by ex vivo gamma counting and autoradiography. 18F-fluorodeoxyglucose PET, dynamic contrast-enhanced MR imaging, and near-infrared fluorescence signals were also significantly higher in atherosclerotic rabbit aortas compared with control aortas. Enhanced liver uptake was also noted in atherosclerotic animals, confirmed by the presence of MAA epitopes by immunostaining. CONCLUSIONS 89Zr-LA25 is a novel PET radiotracer that may allow noninvasive phenotyping of high-risk OSE-rich lesions.

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The Myth of the “Vulnerable Plaque”

Cited by 364 publications

References 90 publications

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Invasive or non-invasive imaging for detecting high-risk coronary lesions?

PET/MR Imaging of Malondialdehyde-Acetaldehyde Epitopes With a Human Antibody Detects Clinically Relevant Atherothrombosis

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