Noninvasive imaging of coronary artery disease: Myth or reality?

摘要

Atherosclerosis and its thrombotic complications are the major cause of mobility and mortality in the modern world.1 Identification of the severity and vulnerability of the culprit atherosclerotic lesion by clinical imaging renders the development of intervention strategies to prevent acute cardiovascular events such as myocardial infarction.2 An ideal clinical imaging modality for atherosclerotic vascular disease should be safe, cost-effective, noninvasive or minimally invasive, accurate, and reproducible, and the results should correlate with the extent of atherosclerotic disease.3 Coronary plaque and its vulnerability can be examined by intravascular ultraso-nography or optical coherence tomography,4 but both techniques are invasive and may not be feasible for routine clinical application. Noninvasive computed tomography and high-resolution magnetic resonance imaging allow not only visualization of coronary artery stenosis but also characterization of plaque composition. Nevertheless, cardiac and respiratory motion currently restricts their effectiveness in the coronary tree.5 Ultrasound imaging is widely available, inexpensive, and well-suited for high-throughput screening in populations that are at risk for atherosclerosis. The carotid intima-media thickness (CBVIT), assessed by B-mode ultrasonography as a simple test assessing structural changes in the arterial wall, has been suggested as a surrogate maker for atherosclerotic disease.3-6 However, the accuracy of CTMT as a marker of atherosclerosis has recently been questioned by the fact that the main predictors of medial hypertrophy or intimal thickening of the common carotid artery are age and hypertension, which do not necessarily reflect the atherosclerotic process.