Document Detail

Detection of high-risk atherosclerotic plaque: report of the NHLBI Working Group on current status and future directions.
MedLine Citation:
PMID:  22974808     Owner:  NLM     Status:  MEDLINE    
The leading cause of major morbidity and mortality in most countries around the world is atherosclerotic cardiovascular disease, most commonly caused by thrombotic occlusion of a high-risk coronary plaque resulting in myocardial infarction or cardiac death, or embolization from a high-risk carotid plaque resulting in stroke. The lesions prone to result in such clinical events are termed vulnerable or high-risk plaques, and their identification may lead to the development of pharmacological and mechanical intervention strategies to prevent such events. Autopsy studies from patients dying of acute myocardial infarction or sudden death have shown that such events typically arise from specific types of atherosclerotic plaques, most commonly the thin-cap fibroatheroma. However, the search in human beings for vulnerable plaques before their becoming symptomatic has been elusive. Recently, the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study demonstrated that coronary plaques that are likely to cause future cardiac events, regardless of angiographic severity, are characterized by large plaque burden and small lumen area and/or are thin-cap fibroatheromas verified by radiofrequency intravascular ultrasound imaging. This study opened the door to identifying additional invasive and noninvasive imaging modalities that may improve detection of high-risk atherosclerotic lesions and patients. Beyond classic risk factors, novel biomarkers and genetic profiling may identify those patients in whom noninvasive imaging for vulnerable plaque screening, followed by invasive imaging for risk confirmation is warranted, and in whom future pharmacological and/or device-based focal or regional therapies may be applied to improve long-term prognosis.
Jerome L Fleg; Gregg W Stone; Zahi A Fayad; Juan F Granada; Thomas S Hatsukami; Frank D Kolodgie; Jacques Ohayon; Roderic Pettigrew; Marc S Sabatine; Guillermo J Tearney; Sergio Waxman; Michael J Domanski; Pothur R Srinivas; Jagat Narula
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  5     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-14     Completed Date:  2013-02-05     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  941-55     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA.
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MeSH Terms
Biological Markers / blood
Carotid Artery Diseases / complications,  diagnosis*,  mortality,  pathology
Coronary Artery Disease / complications,  diagnosis*,  mortality,  pathology
Coronary Vessels / pathology*
Diagnostic Imaging* / methods
Disease Models, Animal
Embolism / etiology,  mortality
Genetic Testing
Myocardial Infarction / etiology,  mortality
Plaque, Atherosclerotic
Predictive Value of Tests
Risk Assessment
Risk Factors
Rupture, Spontaneous
Severity of Illness Index
Stroke / etiology,  mortality
Grant Support
Reg. No./Substance:
0/Biological Markers

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