Vulnerable plaques and patients
| Autor: | Amir Lerman, Akiko Maehara, Yuki Katagiri, Thomas F. Lüscher, Ranil de Silva, Patrick W. Serruys, Ramzi Khamis, Wolfgang Koenig, Yoshinobu Onuma, Renu Virmani, William Wijns, Gregg W. Stone, James E. Muller, Rodrigo Modolo, Ryo Torii, Nick E.J. West, Peter Stone, Jolanda J. Wentzel, Christos V. Bourantas, Frank J. H. Gijsen, Gijs van Soest, Antonius F.W. van der Steen, Mariusz Tomaniak |
|---|---|
| Přispěvatelé: | British Heart Foundation, Cardiology |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Thin-cap fibroatheroma
medicine.medical_specialty Coronary Disease Disease Coronary Artery Disease 030204 cardiovascular system & hematology Acute coronary syndromes medicine.disease_cause Plaque erosion Culprit Sudden cardiac death New invasive coronary imaging modalities 03 medical and health sciences 0302 clinical medicine Pharmacotherapy Intravascular ultrasound medicine Humans Clinical significance 030212 general & internal medicine Acute Coronary Syndrome Intensive care medicine 1102 Cardiorespiratory Medicine and Haematology Vulnerable plaque Cause of death medicine.diagnostic_test business.industry Plaque rupture 1103 Clinical Sciences medicine.disease Atherosclerosis Culprit plaque Plaque Atherosclerotic Death Sudden Cardiac Cardiovascular System & Hematology Current Opinion Cardiology and Cardiovascular Medicine business Cardiovascular pharmacotherapy |
| Zdroj: | Eur Heart J European Heart Journal, 41(31), 2997-3004. Oxford University Press |
| ISSN: | 1522-9645 0195-668X |
| Popis: | Despite advanced understanding of the biology of atherosclerosis, coronary heart disease remains the leading cause of death worldwide. Progress has been challenging as half of the individuals who suffer sudden cardiac death do not experience premonitory symptoms. Furthermore, it is well-recognized that also a plaque that does not cause a haemodynamically significant stenosis can trigger a sudden cardiac event, yet the majority of ruptured or eroded plaques remain clinically silent. In the past 30 years since the term ‘vulnerable plaque’ was introduced, there have been major advances in the understanding of plaque pathogenesis and pathophysiology, shifting from pursuing features of ‘vulnerability’ of a specific lesion to the more comprehensive goal of identifying patient ‘cardiovascular vulnerability’. It has been also recognized that aside a thin-capped, lipid-rich plaque associated with plaque rupture, acute coronary syndromes (ACS) are also caused by plaque erosion underlying between 25% and 60% of ACS nowadays, by calcified nodule or by functional coronary alterations. While there have been advances in preventive strategies and in pharmacotherapy, with improved agents to reduce cholesterol, thrombosis, and inflammation, events continue to occur in patients receiving optimal medical treatment. Although at present the positive predictive value of imaging precursors of the culprit plaques remains too low for clinical relevance, improving coronary plaque imaging may be instrumental in guiding pharmacotherapy intensity and could facilitate optimal allocation of novel, more aggressive, and costly treatment strategies. Recent technical and diagnostic advances justify continuation of interdisciplinary research efforts to improve cardiovascular prognosis by both systemic and ‘local’ diagnostics and therapies. The present state-of-the-art document aims to present and critically appraise the latest evidence, developments, and future perspectives in detection, prevention, and treatment of ‘high-risk’ plaques occurring in ‘vulnerable’ patients. |
| Databáze: | OpenAIRE |
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