Imaging Vulnerable Plaque in a Modern School of Cardiology – the PlaqueImage Project

Abstract

Vulnerable plaques are atheromatous lesions with particular features that make them prone to rupture. Plaque rupture leads to the formation of an intracoronary thrombus, in most of the cases associated with an acute coronary syndrome.The detection of vulnerable plaques is one of the main goals of modern cardiac imaging, and coronary computed tomography angiography remains the reference technique for plaque characterization due to its noninvasive nature associated with the possibility to provide complex information about plaque morphology and composition.The PlaqueImage project started in 2015 with the aim to train a team of researchers in the modern imaging of coronary plaques, making them highly qualified in multimodality cardiac imaging. Along with the progress recorded in understanding the complex mechanisms related to plaque vulnerabilization and rupture, the PlaqueImage project also had the role to train PhD students in modern research methodology. As a result, 14 PhD theses were completed, and a large number of publications on imaging vulnerable plaques were finalized. From the studies initiated by the PhD students, 8 have been published on the clinicaltrials.gov platform in order to validate them from a methodological point of view, and many study protocols of these trials have been published in the form of study designs. Some of them have been finalized, and some of them are still ongoing.The ATHERODENT trial [NCT03395041] aimed to investigate the link between periodontal disease, inflammation, and atherosclerosis progression. 1 The STAFF study investigated the association between in-stent flow hemodynamics and the risk of stent failure following bioresorbable vascular scaffold implantation. 2 The CT-STENT study provides a cost-effectiveness perspective on provisional CT follow-up for MACE reduction after coronary stent implantation. The VIP trial [NCT03606330] investigated the association between systemic, pancoronary, and local plaque vulnerability for image-based prediction of acute coronary syndromes. 3 The GEOMETRY study [NCT03702764] performed a computational assessment of plaque geometry in high-risk coronary lesions, 4 while the STRESS study investigated the role of shear stress derived from im-