Perspectives in Predicting Rapid Plaque Progression and Future Coronary Events Using Comprehensive Plaque and Hemodynamic Assessment

Abstract

Currently, we are implementing a coronary revascularization strategy based on fractional flow reserve inspection, a surrogate marker of functional ischemia. However, physiological and imaging results sometimes do not match. In addition, even when there is no evidence of ischemia through physiological tests, fatal cardiovascular events may still occur due to rapid progression or rupture in a short period. Predicting plaque progression accurately and quantitatively in the future remains a major challenge. So far, there have been many studies to find the characteristics of vulnerable plaque using high-resolution intravascular imaging devices. However, there have still been limitations due to low positive predictive value, high cost, and low accessibility as an invasive test. Recently, researches on models to supplement this by adding hemodynamic parameters and morphological characteristics have been conducted to obtain a higher prediction rate. To simulate detailed biomechanical conditions of the coronary lumen and coronary plaque, accurate image-based 3D vascular segmentation and computational fluid dynamics modeling are required. Through this review, we will discuss the current status and future direction of the mechanisms and techniques of comprehensive plaque and hemodynamic assessment in predicting future cardiac events.