The Relationship Between Plaque Morphology and its Hemodynamic Significance

A 50-year-old woman presents to the office complaining of chest pain upon moderate/severe exertion when attending her aerobics classes. She is an ex-smoker who quit 5 years ago with no other risk factors. In her family history, her father was diagnosed with three-vessel coronary artery disease and had coronary artery bypass grafting at the age of 70. Upon presentation, her temperature is 95 degrees F, heart rate is 75 bpm, blood pressure is 138/84 mmHg, and oxygen saturation is 99%. Her electrocardiogram shows a sinus rhythm at 75 bpm with a left QRS axis and a QTc of 390 ms. She is not routinely taking medications except for occasional use of a homeopathic anxiolytic preparation. In view of her symptoms, she is referred for a coronary computed tomography angiography (CTA) coupled with CT-derived fractional flow reserve measurements (FFRCT). The FFRCT results identify an ischemic lesion at the mid-left anterior descending artery with an FFR value of 0.74.

Which of the following plaque characteristics, as assessed by CTA, is most likely to be present at this ischemic lesion?

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