Identification of obstructive coronary artery disease (CAD) has traditionally constituted the focus for risk stratification in patients with chest pain. Functional stress testing still represents the preponderant modality for chest pain evaluation and invasive coronary angiography the gold standard reference. Even though functional capacity has clear prognostic implications, on its own, it does not include the evaluation of non-obstructive CAD, the plaque burden or additional risk modifying elements beyond epicardial coronary stenosis driven ischemia. It has been demonstrated that location, plaque burden, characteristics and progression, and microvascular disease independently predict MACE. Plaque burden can be evaluated by coronary artery calcium scoring (CAC) and with several qualitative or quantitative methods on CT coronary angiography (CCTA) and microvascular disease can be evaluated non-invasively by positron emission tomography (PET) and stress cardiac magnetic resonance (CMR).
Newer non-invasive evaluation tools have identified risk modifying components beyond coronary stenosis such as plaque burden, high-risk plaque features, epicardial adipose tissue, pericoronary adipose tissue, coronary volume to mass ratio and microvascular ischemia. The effect of lipid therapy based on cardiac CT findings has been explored in a subgroup from the MESA cohort where the number needed to treat (NNT) for MACE was inversely related to CAC and CCTA severity groups. Furthermore, statin and icosapent ethyl (EPA) treatment have shown to produce regression of coronary atherosclerosis and reduction of HRP features. The transition of medical therapy based on purely risk estimators to the complex imaging risk stratification together with an evolving availability of medical therapies create a new paradigm of diagnosis and treatment selection and titration.
Our article collection will consider original research and reviews focusing on non-invasive diagnostic tools beyond coronary stenosis and its implications on medical therapy.
Identification of obstructive coronary artery disease (CAD) has traditionally constituted the focus for risk stratification in patients with chest pain. Functional stress testing still represents the preponderant modality for chest pain evaluation and invasive coronary angiography the gold standard reference. Even though functional capacity has clear prognostic implications, on its own, it does not include the evaluation of non-obstructive CAD, the plaque burden or additional risk modifying elements beyond epicardial coronary stenosis driven ischemia. It has been demonstrated that location, plaque burden, characteristics and progression, and microvascular disease independently predict MACE. Plaque burden can be evaluated by coronary artery calcium scoring (CAC) and with several qualitative or quantitative methods on CT coronary angiography (CCTA) and microvascular disease can be evaluated non-invasively by positron emission tomography (PET) and stress cardiac magnetic resonance (CMR).
Newer non-invasive evaluation tools have identified risk modifying components beyond coronary stenosis such as plaque burden, high-risk plaque features, epicardial adipose tissue, pericoronary adipose tissue, coronary volume to mass ratio and microvascular ischemia. The effect of lipid therapy based on cardiac CT findings has been explored in a subgroup from the MESA cohort where the number needed to treat (NNT) for MACE was inversely related to CAC and CCTA severity groups. Furthermore, statin and icosapent ethyl (EPA) treatment have shown to produce regression of coronary atherosclerosis and reduction of HRP features. The transition of medical therapy based on purely risk estimators to the complex imaging risk stratification together with an evolving availability of medical therapies create a new paradigm of diagnosis and treatment selection and titration.
Our article collection will consider original research and reviews focusing on non-invasive diagnostic tools beyond coronary stenosis and its implications on medical therapy.
