Progress in Interventional Cardiology: Challenges for the Future

Dear Colleagues,

Interventional cardiology focuses on the diagnosis and treatment of cardiovascular diseases. Nowadays, several techniques routinely used in the cath lab allow for establishing a fine diagnosis and, consequently, choosing the best strategy for the treatment of coronary artery disease. Specifically, imaging led to a big jump, providing a clearer view inside the coronary tree to guide diagnosis and optimize the final results of interventional procedures.

The assessment of coronary physiology represents another interesting topic in the field of coronary artery disease. Recently, functional assessment of both the epicardial and microvascular compartments was indicated as being pivotal for diagnosing microvascular and endothelial dysfunction known to be responsible for microvascular and vasospastic angina, respectively. Since these two entities can even overlap with the presence of epicardial disease, a so-called “Full-Physiology” assessment of coronary physiology is crucial to identify the patients who would benefit the most of all the drug- and device-based therapies that are emerging for the treatment of microvascular angina.

Of note, the assessment of epicardial disease is no longer needed to justify a PCI procedure with the finding of a positive FFR value. Even in these cases, it is necessary to understand the pattern of the disease and distinguish between a focal and diffuse atherosclerotic disease. The underestimation of the pattern of the disease can lead to useless and potentially complex procedures without any clinical benefit for patients. The use of virtual software and the pressure wire pullback maneuver is useful for correctly identifying disease patterns.  Finally, post-PCI functional assessment is emerging as a fundamental tool in order to optimize PCI results, avoiding residual angina at follow-up.

Progress in interventional cardiology has not been limited to coronary artery disease only. The treatment of valvular diseases, which was initially limited to the aortic valve, has progressively expanded by including treatment of the mitral, tricuspid, and finally pulmonary valves in selected patients. Thus, percutaneous structural heart interventions are nowadays minimally invasive alternatives to open heart surgery, resulting in quicker recovery times and fewer complications.

Finally, another partially unexplored topic in the field of interventional cardiology is represented by antithrombotic therapy. This is true in acute settings such as acute coronary syndromes and in all other procedures requiring antithrombotic therapy: an excellent result obtained in the cath lab might be ruined by the wrong pharmacological approach!

The aim of this Special Issue will be to collect a series of articles specifically related to interventional cardiology focused on all approaches, both interventional and pharmacological, that might be considered as challenges for the future and important for the progress in interventional cardiology. We look forward to your submissions.

Dr. Luigi Di Serafino
Prof. Dr. Plinio Cirillo
Guest Editors

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• antithrombotics
• coronary artery disease
• functional coronary angiography
• interventional cardiology
• percutaneous coronary intervention
• structural heart interventions