Perspectives in noninvasive imaging for chronic coronary syndromes. (15th October 2022)

• Record Type: Journal Article
• Authors: Morrone, Doralisa; Gentile, Francesco; Aimo, Alberto; Cameli, Matteo; Barison, Andrea; Picoi, Maria Elena; Guglielmo, Marco; Villano, Angelo; DeVita, Antonio; Mandoli, Giulia Elena; Pastore, Maria Concetta; Barillà, Francesco; Mancone, Massimo; Pedrinelli, Roberto; Indolfi, Ciro; Filardi, Pasquale Perrone; Muscoli, Saverio; Tritto, Isabella; Bergamaschi, Luca; Pizzi, Carmine; Camici, Paolo G.; Marzilli, Mario; Crea, Filippo; Caterina, Raffaele De; Pontone, Gianluca; Neglia, Danilo; Lanza, Gaetano A.
• Is Part Of: International journal of cardiology. Volume 365(2022)
• Page Start: 19
• Page End: 29
• Publication Date: 2022-10-15
• Subjects: Myocardial ischemia -- Imaging -- Echocardiography -- Cardiac magnetic resonance -- Nuclear imaging -- CCTA; CAD coronary atherosclerotic disease -- CCS chronic coronary syndrome -- CCTA coronary computed tomography angiography -- CFVR coronary flow velocity reserve -- CMR cardiac magnetic resonance -- CTP computed tomography perfusion imaging -- ECG electrocardiogram -- FFR fractional flow reserve -- GLS global longitudinal strain -- ICA invasive coronary angiography -- LAD left anterior descending coronary artery -- LGE late gadolinium enhancement -- LVEF left ventricle ejection fraction -- MBF myocardial blood flow -- MCE myocardial contrast echocardiography -- MI myocardial infarction -- MPI myocardial perfusion imaging -- PAD posterior descending coronary artery -- PET positron emission tomography -- PSS post-systolic shortening -- PTP pre-test probability -- SE stress echocardiography -- SPECT single photon emission computed tomography -- STE speckle tracking echocardiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.07.038
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Both the latest European guidelines on chronic coronary syndromes and the American guidelines on chest pain have underlined the importance of noninvasive imaging to select patients to be referred to invasive angiography. Nevertheless, although coronary stenosis has long been considered the main determinant of inducible ischemia and symptoms, growing evidence has demonstrated the importance of other underlying mechanisms (e.g., vasospasm, microvascular disease, energetic inefficiency). The search for a pathophysiology-driven treatment of these patients has therefore emerged as an important objective of multimodality imaging, integrating "anatomical" and "functional" information. We here provide an up-to-date guide for the choice and the interpretation of the currently available noninvasive anatomical and/or functional tests, focusing on emerging techniques (e.g., coronary flow velocity reserve, stress-cardiac magnetic resonance, hybrid imaging, functional-coronary computed tomography angiography, etc.), which could provide deeper pathophysiological insights to refine diagnostic and therapeutic pathways in the next future. Graphical abstract: CCTA allows a comprehensive assessment of CAD, while traditional functional imaging is aimed to assess myocardial ischemia. Since ischemia may be secondary either to epicardial coronary obstructive or to other conditions (e.g., vasospasm, microvascular dysfunction, energetic mismatch), the use of more modern techniques such as FFRCT, stress-CTP, CFVR, stress-CMR, and hybrid imaging may provide further information to tailor therapeutic choices to each patient. CAD: coronary atherosclerotic disease; CCTA: coronary computed tomography angiography; CFVR: coronary flow velocity reserve; CMR: cardiac magnetic resonance; CTP, computed tomography perfusion imaging; FFR, fractional flow reserve; MPI, myocardial perfusion imaging. Unlabelled Image Highlights: Both the latest European guidelines on chronic coronary syndromes and the American guidelines on chest pain have underlined the importance of noninvasive imaging. Other mechanisms than coronary stenosis (e.g., vasospasm, microvascular disease, energetic inefficiency) may underly inducible ischemia and symptoms. The search for a pathophysiology-driven treatment of these patients is an important objective of multimodality imaging, integrating "anatomical" and "functional" information.