Contemporary rationale for non-invasive imaging of adverse coronary plaque features to identify the vulnerable patient: a Position Paper from the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology and the European Association of Cardiovascular Imaging

Marc R. Dweck, Pal Maurovich-Horvat, Tim Leiner, Bernard Cosyns, Zahi A. Fayad, Frank J. H. Gijsen, Kim Van der Heiden, M. Eline Kooi, Akiko Maehara, James E. Muller, David E. Newby, Jagat Narula, Gianluca Pontone, Evelyn Regar, Patrick W. Serruys, Antonius F. W. van der Steen, Peter H. Stone, Johannes L. Waltenberger, Chun Yuan, Paul C. EvansEsther Lutgens, Jolanda J. Wentzel, Magnus Back*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

37 Downloads (Pure)


Atherosclerotic plaques prone to rupture may cause acute myocardial infarction (MI) but can also heal without causing an event. Certain common histopathological features, including inflammation, a thin fibrous cap, positive remodelling, a large necrotic core, microcalcification, and plaque haemorrhage are commonly found in plaques causing an acute event. Recent advances in imaging techniques have made it possible to detect not only luminal stenosis and overall coronary atherosclerosis burden but also to identify such adverse plaque characteristics. However, the predictive value of identifying individual adverse atherosclerotic plaques for future events has remained poor. In this Position Paper, the relationship between vulnerable plaque imaging and MI is addressed, mainly for non-invasive assessments but also for invasive imaging of adverse plaques in patients undergoing invasive coronary angiography. Dynamic changes in atherosclerotic plaque development and composition may indicate that an adverse plaque phenotype should be considered at the patient level rather than for individual plaques. Imaging of adverse plaque burden throughout the coronary vascular tree, in combination with biomarkers and biomechanical parameters, therefore holds promise for identifying subjects at increased risk of MI and for guiding medical and invasive treatment.

Original languageEnglish
Pages (from-to)1177-1183
Number of pages7
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number11
Publication statusPublished - Nov 2020


  • atherosclerosis
  • computed tomography
  • inflammation
  • magnetic resonance imaging
  • vulnerable plaque

Cite this