Sigita GlaveckaiteVilnius University , Lithuania
Title: Coronary atherosclerosis: From imaging progress to plaque regression
Coronary artery disease represents the most common cardiovascular disease, with high morbidity and mortality. Historically, patients with chest pain of suspected coronary origin have been assessed with functional imaging tests, capable to detect hemodynamic consequences of coronary stenosis through depiction of myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography, single-photon emission computed tomography, positron emission tomography and cardiovascular magnetic resonance represent the functional imaging techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, coronary computed tomography angiography has been developed as a non-invasive anatomical test for a direct visualization of coronary vessels and detailed description of atherosclerotic plaque burden. Computed tomography (CT) became recently one-stop-shop for chest pain evaluation, because it provides all information we need – from anatomical (coronary stenosis, plaque burden, plaque composition) to functional (noninvasive fractional flow reserve, perivascular adipose tissue attenuation, myocardial perfusion). Thus, coronary imaging paradigm after publication of clinical trials (ISCHEMIA, ISCHEMIA EXTEND, SCOT-HEART, PROMISE) is switching from the assessment of ischemia to plaque characterization. Assessment of high-risk plaque features provides valuable information for risk assessment and tailoring of preventive treatment. It seems, that “stabilization” of the coronary plaque rather than myocardial ischemia reduction is related to the improved prognosis. Despite evidence that statins and PCSK9 inhibitors are capable to change coronary plaque composition to the more favourable one, there is a lack of data on CT guided preventive therapy to reduce plaque volume and transform favourably composition of the plaque. In the future personalized assessment of coronary plaque burden and their characteristics seems to be a standard to select the optimal treatment and evaluate response to therapies.
Sigita Glaveckaite is working as a Cardiologist – consultant and Head of Cardiovascular Imaging Department at Vilnius University hospital Santaros klinikos , head of the Clinic of Cardiac and Vascular diseases at Vilnius University. She is the President of the Lithuanian Heart Association. Her main scientific and clinical interests are acquired valvular heart diseases, chronic coronary syndromes, aorthopathies and cardiovascular imaging with particular emphasis on cardiovascular magnetic resonance.