Infante Teresa, Forte Ernesto, Schiano Concetta, Cavaliere Carlo, Tedeschi Carlo, Soricelli Andrea, Salvatore Marco, Napoli Claudio
IRCCS SDNNaples, Italy.
Department of Cardiology, San Giovanni Bosco HospitalASL Napoli 1, Naples, Italy.
Am J Transl Res. 2017 Jul 15;9(7):3148-3166. eCollection 2017.
The major issue in coronary heart disease (CHD) diagnosis and management is that symptoms onset in an advanced state of disease. Despite the availability of several clinical risk scores, the prediction of cardiovascular events is lacking, and many patients at risk are not well stratified according to the canonical risk factors alone. Therefore, adequate risk assessment remains the most challenging issue. Recently, the integration of imaging data with biochemical markers in a radiogenomic framework has been proposed in many fields of medicine as well as in cardiology. Multimodal imaging and advanced processing techniques can provide both direct (e.g., remodeling index, calcium score, total plaque volume, plaque burden) and indirect (e.g., myocardial perfusion index, coronary flow reserve) imaging features of CHD. Furthermore, the identification of novel non-invasive biochemical markers, mainly focused on plasma and/or serum samples, has increased the specificity of findings, reflecting several pathophysiological pathways of atherosclerosis, the principal actor in CHD. In this context, a multifaced approach, derived from the strengths of all these modalities, appears promising for finer risk stratification and treatment strategies, facilitating the decision-making and clinical management of patients. This review underlines the role of different imaging modalities in the quantification of coronary atherosclerosis and describes novel blood-based markers that could improve diagnosis and have a better predictive value in CHD.
冠心病（CHD）诊断和管理中的主要问题是症状在疾病晚期才出现。尽管有几种临床风险评分方法，但心血管事件的预测仍存在不足，仅根据典型风险因素，许多有风险的患者并未得到很好的分层。因此，充分的风险评估仍然是最具挑战性的问题。最近，在医学的许多领域以及心脏病学中，都有人提出在放射基因组学框架中将成像数据与生化标志物相结合。多模态成像和先进的处理技术可以提供冠心病的直接（例如，重构指数、钙化积分、总斑块体积、斑块负荷）和间接（例如，心肌灌注指数、冠状动脉血流储备）成像特征。此外，主要针对血浆和/或血清样本的新型非侵入性生化标志物的识别提高了研究结果的特异性，反映了动脉粥样硬化的几种病理生理途径，而动脉粥样硬化是冠心病的主要病因。在这种背景下，源自所有这些方法优势的多方面方法，对于更精细的风险分层和治疗策略似乎很有前景，有助于患者的决策制定和临床管理。本综述强调了不同成像方式在冠状动脉粥样硬化量化中的作用，并描述了可改善冠心病诊断并具有更好预测价值的新型血液标志物。
