Department of Cardiology, Peninsula Health, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Victoria, Australia.
Monash University, Melbourne, Victoria, Australia.
J Am Coll Cardiol. 2022 Jan 4;79(1):66-82. doi: 10.1016/j.jacc.2021.10.035.
Over the last 3 decades there have been substantial improvements in treatments aimed at reducing cardiovascular (CV) events. As these treatments have been developed, there have been parallel improvements in coronary imaging modalities that can assess plaque volumes and composition, using both invasive and noninvasive techniques. Plaque progression can be seen to precede CV events, and therefore, many studies have longitudinally assessed changes in plaque characteristics in response to various treatments, aiming to demonstrate plaque regression and improvements in high-risk features, with the rationale being that this will reduce CV events. In the past, decisions surrounding treatments for atherosclerosis have been informed by population-based risk scores for initiation in primary prevention and low-density lipoprotein cholesterol levels for titration in secondary prevention. If outcome data linking plaque regression to reduced CV events emerge, it may become possible to directly image plaque treatment response to guide management decisions.
在过去的 30 年中，针对降低心血管（CV）事件的治疗方法取得了实质性的进展。随着这些治疗方法的发展，评估斑块体积和成分的冠状动脉成像方式也得到了同步改进，包括有创和无创技术。斑块进展可以先于 CV 事件发生，因此，许多研究已经对各种治疗方法下的斑块特征变化进行了纵向评估，旨在证明斑块消退和高危特征的改善，其基本原理是这将降低 CV 事件的发生风险。过去，针对动脉粥样硬化的治疗决策是基于人群的风险评分，用于一级预防的起始治疗，以及低密度脂蛋白胆固醇水平，用于二级预防的滴定治疗。如果出现将斑块消退与降低 CV 事件相关联的结果数据，那么直接对斑块治疗反应进行成像以指导管理决策可能成为可能。
