title: Imaging of coronary atherosclerosis - evolution towards new treatment strategies.
abstract: Coronary atherosclerosis and the precipitation of acute myocardial infarction are highly complex processes, which makes accurate risk prediction challenging. Rapid developments in invasive and noninvasive imaging technologies now provide us with detailed, exquisite images of the coronary vasculature that allow direct investigation of a wide range of these processes. These modalities include sophisticated assessments of luminal stenoses and myocardial perfusion, complemented by novel measures of the atherosclerotic plaque burden, adverse plaque characteristics, and disease activity. Together, they can provide comprehensive, individualized assessments of coronary atherosclerosis as it occurs in patients. Not only can this information provide important pathological insights, but it can also potentially be used to guide personalized treatment decisions. In this Review, we describe the latest advances in both established and emerging imaging techniques, focusing on the strengths and weakness of each approach. Moreover, we discuss how these technological advances might be translated from attractive images into novel imaging strategies and definite improvements in clinical risk prediction and patient outcomes. This process will not be easy, and the many potential barriers and difficulties are also reviewed.
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.|Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, New York 10029, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Dweck
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
authors.forename: Mhairi K
authors.initials: MK
authors.lastname: Doris
authors.affiliation: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Motwani
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Adamson
authors.affiliation: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048, USA.
authors.forename: Piotr
authors.initials: P
authors.lastname: Slomka
authors.affiliation: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048, USA.
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.affiliation: Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, New York 10029, USA.
authors.forename: Zahi A
authors.initials: ZA
authors.lastname: Fayad
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berman
mesh_terms: D057791:Cardiac Imaging Techniques; D000066491:Clinical Decision-Making; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index