[Plaque characterization and individualized risk assessment].

Autor: Brendel JM; Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland.; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Nikolaou K; Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland., Foldyna B; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. bfoldyna@mgh.harvard.edu.
Jazyk: němčina
Zdroj: Radiologie (Heidelberg, Germany) [Radiologie (Heidelb)] 2024 Dec; Vol. 64 (12), pp. 946-955. Date of Electronic Publication: 2024 Nov 12.
DOI: 10.1007/s00117-024-01385-y
Abstrakt: Clinical/methodical Issue: Risk assessment and accurate plaque characterization are key to individual prognosis in coronary artery disease (CAD).
Standard Radiological Methods: The standard of care is cardiac computed tomography (CT), including calcium scoring and coronary CT angiography (CCTA). Diagnosis is based on the CAD-RADS (Coronary Artery Disease-Reporting and Data System) classification.
Methodological Innovations: New developments include CT-based fractional flow reserve (CT-FFR) and plaque quantification ("virtual histology").
Performance: A calcium score of 0 indicates an event risk of less than 1% over 10 years [7, 17]. CAD-RADS classes 1 to 5 allow risk assessment compared to patients without coronary plaques [2]. CT-FFR has high accuracy (area under the curve [AUC] 0.90; 95% confidence interval 0.87-0.94) in assessing the hemodynamic significance of stenoses compared with invasive coronary angiography [25]. Plaque quantification has shown that a necrotic core greater than 4% is associated with an almost fivefold increase in 5‑year event risk [29].
Achievements: The presence of obstructive CAD (stenosis > 50%) is a strong prognostic factor. The evaluation of the hemodynamic relevance of 40-90% stenoses by CT-FFR or other functional tests is already guideline-compliant in the USA, but not yet in Germany. Quantitative approaches to measure plaque volume and composition are gaining importance in research and are expected to become relevant in clinical practice.
Practical Recommendations: The CAD-RADS 2.0 classification, which also provides therapy recommendations, should be used to assess the extent of CAD.
Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: J. M. Brendel, K. Nikolaou und B. Foldyna geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
(© 2024. The Author(s).)
Databáze: MEDLINE
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