Physiological predictors of acute coronary syndromes: emerging insights from the plaque to the vulnerable patient

Ford, T. J. , Berry, C. , De Bruyne, B., Yong, A. C.S., Barlis, P., Fearon, W. F. and Ng, M. K.C. (2017) Physiological predictors of acute coronary syndromes: emerging insights from the plaque to the vulnerable patient. JACC: Cardiovascular Interventions, 10(24), pp. 2539-2547. (doi:10.1016/j.jcin.2017.08.059) (PMID:29268883)

[img] Text
154591.pdf - Accepted Version
Restricted to Repository staff only until 18 December 2018.

828kB

Abstract

In this review, the authors explore the evolving evidence linking physiological assessment of coronary artery disease with plaque progression and vulnerability. Reducing adverse clinical events remains the ultimate goal for diagnostic tests, and this review highlights evidence supporting the prognostic value of physiological metrics in predicting outcomes. Historical and contemporary studies support synergy among lesion severity, ischemia, plaque vulnerability, and patient prognosis. Ischemia contributes to clinical events through association with plaque burden, but this review addresses the emerging concept that it associates with atherothrombosis via disturbed lesion hemodynamics. Biomechanical pathophysiological forces including endothelial shear stress-the frictional force generated by blood flow on the vessel wall-are increasingly linked with atherogenesis, vulnerable plaque morphology, and platelet and leukocyte activation. The authors conclude by transitioning from the model of the vulnerable plaque to the concept of the "vulnerable patient," looking more broadly at physiological contributors to Virchow's triad underpinning acute coronary syndrome.

Item Type:Articles
Keywords:Acute coronary syndromes(s), coronary physiology, endothelial shear stress, mechanisms of atherosclerosis, plaque vulnerability.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Ford, Thomas
Authors: Ford, T. J., Berry, C., De Bruyne, B., Yong, A. C.S., Barlis, P., Fearon, W. F., and Ng, M. K.C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:JACC: Cardiovascular Interventions
Publisher:Elsevier
ISSN:1936-8798
ISSN (Online):1876-7605
Published Online:18 December 2017
First Published:First published in JACC: Cardiovascular Interventions 10(24):2539-2547
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

University Staff: Request a correction | Enlighten Editors: Update this record