TOTAL PLAQUE BURDEN
The concept of plaque burden – as opposed to the concept of vulnerable plaque – has gained more attention in 2015. Thousands of studies were performed using sophisticated hard and soft ware along with mostly invasive techniques that go along with irradiation. Valentin Fuster summarized the results in an overview about this topic: The Myth of the “Vulnerable Plaque” Transitioning From a Focus on Individual Lesions to Atherosclerotic Disease Burden for Coronary Artery Disease Risk Assessment: “However, all of these studies claiming independent risk prediction of certain plaque features share the fundamental limitation that the atherosclerotic disease burden was not considered as a potential confounder. These “high risk” features are conceivably mere markers of more extensive and/or active atherosclerotic disease compared with the control group. Given the overwhelming evidence for disease burden as a powerful predictor of outcome, any additional risk features should be assessed against it before we assume independent risk prediction. Therefore, despite promising results from a number of clinical studies, there is no conclusive evidence for truly independent risk prediction associated with high-risk plaque features”.
The importance of 2D total plaque area of carotid arteries (TPA) to prognosticate major cardiac events (MACE) in comparison to the Framingham Risk Score (FRS) and coronary calcifications (CAC) was shown in the Bioimage study. Importantly both TPA and CAC were independent predictors beyond FRS, but TPA maintained prognostic power for MACE even in those with a CAC=0.