Heterogeneity of Coronary Plaque Morphology and Natural History: Current Understanding and Clinical Significance.
OBJECTIVE
Despite the important progress in identifying high-risk atherosclerotic plaques, many key elements are elusive. Advanced imaging modalities provide valuable information about the anatomic and functional plaque characteristics and underscore the presence of multiple plaque morphologies. However, how the heterogeneity of atherosclerotic plaque can alter our current understanding of coronary artery disease is not fully understood.


RESULTS
Along the length of an individual plaque, the morphology patterns display marked heterogeneity. Contrary to previous beliefs, plaque morphology is also highly dynamic over time, with the vast majority of high-risk plaques becoming quiescent and mild plaques becoming severely obstructive in a short period of time. Endothelial shear stress, a local hemodynamic factor known for its critical effects in plaque initiation and progression, also displays longitudinal heterogeneity contributing to the arterial wall response in all time points. Risk stratification of plaques based on the morphological characteristics at one region of the plaque, usually the minimal lumen diameter, and at one point in time may be misleading. The evaluation of both morphological and hemodynamic characteristics along the length of a plaque will improve the risk assessment of individual plaques.
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Marina
M
Zaromytidou
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Antonios P
AP
Antoniadis
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Gerasimos
G
Siasos
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Ahmet Umit
AU
Coskun
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Ioannis
I
Andreou
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Michail I
MI
Papafaklis
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Michelle
M
Lucier
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Charles L
CL
Feldman
Vascular Profiling Research Laboratory, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA. PSTONE@PARTNERS.ORG.
Peter H
PH
Stone
D000818:Animals; D003327:Coronary Disease / Q000503:physiopathology*; D018450:Disease Progression; D006439:Hemodynamics; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000503:physiopathology*; D018570:Risk Assessment; D013312:Stress, Physiological
Atherosclerosis; Coronary artery disease; Endothelial shear stress; High-risk plaque; Plaque heterogeneity; Plaque morphology