Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Coronary Physiology-Based Approaches for Plaque Vulnerability: Implications for Risk Prediction and Treatment Strategies

  • Seokhun Yang (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine) ;
  • Bon-Kwon Koo (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine)
  • Received : 2023.05.02
  • Accepted : 2023.05.19
  • Published : 2023.09.01
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Abstract

In the catheterization laboratory, the measurement of physiological indexes can help identify functionally significant lesions and has become one of the standard methods to guide treatment decision-making. Plaque vulnerability refers to a coronary plaque susceptible to rupture, enabling risk prediction before coronary events, and it can be detected by defining a certain type of plaque morphology on coronary imaging modalities. Although coronary physiology and plaque vulnerability have been considered different attributes of coronary artery disease, the underlying pathophysiological basis and clinical data indicate a strong correlation between coronary hemodynamic properties and vulnerable plaque. In prediction of coronary events, emerging data have suggested independent and additional implications of a physiology-based approach to a plaque-based approach. This review covers the fundamental interplay between coronary physiology and plaque morphology during disease progression with clinical data supporting this relationship and examines the clinical relevance of physiological indexes in prediction of clinical outcomes and therapeutic decision-making along with plaque vulnerability.

Keywords

Acknowledgement

Dr. Bon-Kwon Koo received an Institutional Research Grant from Abbott Vascular, Philips Volcano, Boston Scientific, and HeartFlow.

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