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Pezzola E, Tomasoni D, Metra M, Adamo M. Coronary artery disease: novel insights in a long-standing disease. J Cardiovasc Med (Hagerstown) 2023; 24:396-399. [PMID: 37285273 DOI: 10.2459/jcm.0000000000001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Elisa Pezzola
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Parry R, Majeed K, Pixley F, Hillis GS, Francis RJ, Schultz CJ. Unravelling the role of macrophages in cardiovascular inflammation through imaging: a state-of-the-art review. Eur Heart J Cardiovasc Imaging 2022; 23:e504-e525. [PMID: 35993316 DOI: 10.1093/ehjci/jeac167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular disease remains the leading cause of death and disability for patients across the world. Our understanding of atherosclerosis as a primary cholesterol issue has diversified, with a significant dysregulated inflammatory component that largely remains untreated and continues to drive persistent cardiovascular risk. Macrophages are central to atherosclerotic inflammation, and they exist along a functional spectrum between pro-inflammatory and anti-inflammatory extremes. Recent clinical trials have demonstrated a reduction in major cardiovascular events with some, but not all, anti-inflammatory therapies. The recent addition of colchicine to societal guidelines for the prevention of recurrent cardiovascular events in high-risk patients with chronic coronary syndromes highlights the real-world utility of this class of therapies. A highly targeted approach to modification of interleukin-1-dependent pathways shows promise with several novel agents in development, although excessive immunosuppression and resulting serious infection have proven a barrier to implementation into clinical practice. Current risk stratification tools to identify high-risk patients for secondary prevention are either inadequately robust or prohibitively expensive and invasive. A non-invasive and relatively inexpensive method to identify patients who will benefit most from novel anti-inflammatory therapies is required, a role likely to be fulfilled by functional imaging methods. This review article outlines our current understanding of the inflammatory biology of atherosclerosis, upcoming therapies and recent landmark clinical trials, imaging modalities (both invasive and non-invasive) and the current landscape surrounding functional imaging including through targeted nuclear and nanobody tracer development and their application.
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Affiliation(s)
- Reece Parry
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
| | - Kamran Majeed
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Waikato District Health Board, Hamilton 3204, New Zealand
| | - Fiona Pixley
- School of Biomedical Sciences, Pharmacology and Toxicology, University of Western Australia, Perth 6009, Australia
| | - Graham Scott Hillis
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
| | - Roslyn Jane Francis
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth 6009, Australia
| | - Carl Johann Schultz
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
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Cardiovascular Imaging Techniques for Detection of Vulnerable Plaques. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Various cardiovascular imaging techniques were developed for the detection of vulnerable atherosclerotic plaques, hoping to be able to predict a cardiovascular event. Plaque vulnerability results from compound pathophysiological mechanisms that lead to structural and morphological changes in lesions. The aim of this review is to present the most recent techniques for the assessment of vulnerable coronary plaques such as cardiac computed tomography angiography (CCTA), optical coherence tomography, or virtual histology intravascular ultra-sound, based on literature data from the last 3 years. CCTA permits direct visualization of the intravascular lumen, together with characterization of the arterial wall. Recent studies maintain that low-attenuation plaques, spotty calcifications, positive vessel remodeling, and the napkin-ring sign are considered main markers of plaque vulnerability and instability. Emerging analytical techniques, such as machine learning or radiomics, will probably demonstrate useful as an auxiliary diagnostic tool for vulnerable plaque detection. The data from the two imaging techniques together provide useful information, especially in patients undergoing a PCI procedure for an acute coronary syndrome. Invasive and noninvasive imaging techniques are able to deliver a large amount of scientific data to assess vulnerable coronary atheromatous plaques. Recent studies demonstrated that information defined by the two techniques is complementary, and using both methods is essential for adequate diagnosis, therapeutic strategy, and prognostic assessment.
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Pescetelli I, Perfetti M, Zimarino M. Beyond plaque stenosis, into plaque composition, the answer comes from optical coherence tomography. J Cardiovasc Med (Hagerstown) 2020; 21:866-868. [DOI: 10.2459/jcm.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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