title: The value of imaging in subclinical coronary artery disease.
abstract: Although the treatment of acute coronary syndromes (ACS) has advanced considerably, the ability to detect, predict, and prevent complications of atherosclerotic plaques, considered the main cause of ACS, remains elusive. Several imaging tools have therefore been developed to characterize morphological determinants of plaque vulnerability, defined as the propensity or probability of plaques to complicate with coronary thrombosis, able to predict patients at risk. By utilizing both intravascular and noninvasive imaging tools, indeed prospective longitudinal studies have recently provided considerable knowledge, increasing our understanding of determinants of plaque formation, progression, and instabilization. In the present review we aim at 1) critically analyzing the incremental utility of imaging tools over currently available "traditional" methods of risk stratification; 2) documenting the capacity of such modalities to monitor atherosclerosis progression and regression according to lifestyle modifications and targeted therapy; and 3) evaluating the potential clinical relevance of advanced imaging, testing whether detection of such lesions may guide therapeutic decisions and changes in treatment strategy. The current understanding of modes of progression of atherosclerotic vascular disease and the appropriate use of available diagnostic tools may already now gauge the selection of patients to be enrolled in primary and secondary prevention studies. Appropriate trials should now, however, evaluate the cost-effectiveness of an aggressive search of vulnerable plaques, favoring implementation of such diagnostic tools in daily practice.
authors: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy. Electronic address: m.zimarino@unich.it.
authors: Marco
authors: M
authors: Zimarino
authors: San Giovanni Addolorata Hospital, CLI-Foundation, Rome, Italy.
authors: Francesco
authors: F
authors: Prati
authors: Department of Radiological Sciences, Institute of Radiology "A. Gemelli" University Polyclinic Foundation, Catholic University, Rome, Italy.
authors: Riccardo
authors: R
authors: Marano
authors: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors: Francesca
authors: F
authors: Angeramo
authors: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors: Irene
authors: I
authors: Pescetelli
authors: San Giovanni Addolorata Hospital, CLI-Foundation, Rome, Italy.
authors: Laura
authors: L
authors: Gatto
authors: San Giovanni Addolorata Hospital, CLI-Foundation, Rome, Italy.
authors: Valeria
authors: V
authors: Marco
authors: Institute of Nuclear Medicine, "A. Gemelli" University Polyclinic Foundation, Catholic University, Rome, Italy.
authors: Isabella
authors: I
authors: Bruno
authors: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors: Raffaele
authors: R
authors: De Caterina
mesh_terms: D058070:Asymptomatic Diseases; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003952:Diagnostic Imaging / Q000379:methods*; D018450:Disease Progression; D006801:Humans; D018810:Magnetic Resonance Angiography; D061330:Multidetector Computed Tomography; D058226:Plaque, Atherosclerotic; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012422:Rupture, Spontaneous; D019265:Spectroscopy, Near-Infrared; D015899:Tomography, Emission-Computed, Single-Photon; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional
keywords: Angiography; Atherosclerosis; Coronary artery disease; Coronary-CT angiography; IVUS; Imaging; Inflammation; NIRS; OCT; Plaque; Thin-cap fibroatheroma