Ultrasound imaging versus morphopathology in cardiovascular diseases. Coronary atherosclerotic plaque

Amongst the clinical approaches ultrasound imaging is one of the more promising technique to understand dysfunction. The need is to compare morphopathological counterpart to have a correct pathophysiological interpretation.In four reviews, morphopathology of the main cardiovascular disorders, in relation to the status of art of clinical imaging will be presented. The aim is to recall the pathological anatomy to stimulate ultrasound experts to further sharpen their technology till "histological" perfection.The present first review concerns the coronary atherosclerosis since the current dogma of "unifying theory" assumes that the acute coronary syndromes, namely unstable angina, myocardial infarct and sudden death, are caused by atherosclerotic plaque rupture or "explosion" with occlusive thrombus formation preceded by intramyocardial emboli. An assumption which implies to discover a clinical imaging able to show when a coronary atherosclerotic plaque becomes vulnerable i.e. prone to rupture.The risk of the latter has been correlated with large lipid core (atheroma in our definition), thin fibrous cap (< 65 μm) covering atheroma. Therefore any imaging should have a 50 μm resolution to identify a fibrous cap prone to rupture, 100 μm or 150 μm thickness being respectively at low or minimal risk. Matrix-digesting enzymes released from inflammatory cells (monocytes, macrophages, T-cells, B-cells, neutrophils, mastcells) may contribute to plaque rupture. An attractive approach since, despite many years of preventive and therapeutical attempts, coronary heart disease (CHD) remains the main cause of death and morbidity in advanced societies and selects people at the top of their work skillness and productivity.The first question is whether ultrasound imaging may or may not discriminate extent and morphology of plaque variables seen within the intima.Morphology of the atherosclerotic plaque has been described in textbook and articles [1-4]. In comparing many contributions, th