Vulnerable Plaque Characteristics at Coronary Computed Tomography Angiography

Medakovic, Petar and Jukic, Mladen and Biloglav, Zrinka (2023) Vulnerable Plaque Characteristics at Coronary Computed Tomography Angiography. Cardiologia Hungarica, 53 (6). pp. 560-570. ISSN 0133-5596

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Abstract

According to morbidity and mortality indicators, cardiovascular diseases are the leading public health issue in the Re- public of Croatia and the European Union. Although mortality rates from ischemic disease have been reduced, Croatia is still categorized among countries with high cardiovascular risk. The guidelines of the European Society of Cardiology from 2020 for acute coronary syndrome (ACS) in patients with low to intermediate risk of coronary atherosclerotic heart disease (CHD) recommend coronary computed tomography angiography (CCTA) as an alternative to invasive corona- rography. In most patients with suspicion of CHD, CCTA leads to the diagnosis of non-obstructive diseases, which caus- es the majority of ACS cases. Multi-slice Computed Tomography scanners of the newest generation employ low doses of radiation and low contrast volume to reliably show the characteristics of vulnerable plaque: (i) positive remodeling, (ii) low attenuation plaque, (iii) spotty calcification, and the (iv) napkin-ring sign. Due to positive remodeling, these plaques are often non-obstructive, and according to the CAD-RADS 2.0 guidelines from 2022 all their characteristics should be specifically emphasized in CCTA findings. Based on the assessment of the prognostic value of vulnerable plaque char- acteristics for adverse cardiac events, CCTA has been shown to be equally valid as other invasive diagnostic methods. Additionally, it was shown to be useful in indicating the optimal medication therapy and monitoring its effects. The results of large international randomized trials indicate the direction of the treatment approach for vulnerable plaque.

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