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Cardiac Magnetic Resonance (CMR), Coronary Computed Tomography Angiography (CCTA) and...
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Cardiac Magnetic Resonance (CMR), Coronary Computed Tomography Angiography (CCTA) and Invasive Functional Assessment in Coronary Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 14976

Special Issue Editor

Dr. Matteo Tebaldi

E-Mail Website
Guest Editor
Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
Interests: coronary diseases; invasive functional evaluation; microvascular disfunction; FFR; DFR; RFR; IMR; CFR

Special Issue Information

Dear Colleagues,

In recent years, the diagnostic approach and therapeutic management of patients with coronary heart disease has changed dramatically. The possibility of performing an accurate non-invasive diagnostics (i.e., CCTA) capable of discriminating patients who may benefit from a subsequent interventional procedure has found its consecration in important international studies (ISCHEMIA trial—N Engl J Med 2020;382:1395-407.). In the same way, the possibility of having accurate data on myocardial viability (i.e., CMR) has made coronary angioplasty an increasingly precise and effective tool for the patient. In this panorama, having both hyperemic (e.g., FFR) and non-hyperemic (e.g., iFR) functional evaluation indices has made it possible to better treat patients who do not have pre-procedure evaluations, significantly reducing inappropriate angioplasty and the number of stents implanted. At the same time, the evaluation both by CMR and by pressure wire (IMR, CFR) of the coronary microcirculation in addition to pharmacological tests (e.g., acetylcholine) has allowed us to better classify the various types of angina (e.g., microvascular angina, vasospastic angina). This “Copernican Revolution” in the management of coronary heart disease has introduced numerous research insights. The purpose of this Special Issue is to analyze the new discoveries in the field of coronary heart disease by focusing on research in the invasive and non-invasive diagnostic field.

Dr. Matteo Tebaldi
Guest Editor

Manuscript Submission Information

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Keywords

  • Functional evaluation
  • Ischemic burden
  • Myocardial viability
  • Microvascular function
  • Coronary diseases

Published Papers (4 papers)

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Research

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13 pages, 2386 KiB  
Article
Coronary Microvascular Dysfunction in Takotsubo Syndrome Assessed by Angiography-Derived Index of Microcirculatory Resistance: A Pressure-Wire-Free Tool
by Jordi Sans-Roselló, Estefanía Fernández-Peregrina, Albert Duran-Cambra, Jose Carreras-Mora, Alessandro Sionis, Jesús Álvarez-García and Hector M. Garcia-Garcia
J. Clin. Med. 2021, 10(19), 4331; https://doi.org/10.3390/jcm10194331 - 23 Sep 2021
Cited by 15 | Viewed by 2170
Abstract
Background: Coronary microvascular dysfunction (CMD) has been proposed as a key mechanism in Takotsubo syndrome (TTS). The non-hyperaemic angiography-derived index of microcirculatory resistance (NH-IMRangio) has been validated as a pressure-wire-free tool for the assessment of coronary microvasculature. We aimed to study the presence [...] Read more.
Background: Coronary microvascular dysfunction (CMD) has been proposed as a key mechanism in Takotsubo syndrome (TTS). The non-hyperaemic angiography-derived index of microcirculatory resistance (NH-IMRangio) has been validated as a pressure-wire-free tool for the assessment of coronary microvasculature. We aimed to study the presence of CMD in TTS patients and its association with levels of cardiac biomarkers and systolic dysfunction patterns. Methods: We recruited 181 consecutive patients admitted for TTS who underwent cardiac angiography at a tertiary center from January 2014 to January 2021. CMD was defined as an NH-IMRangio ≥ 25. Plasma levels of NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT) and the left ventricular ejection fraction (LVEF) by echocardiography were measured at admission. Results: Mean age was 75.3 years, 83% were women and median LVEF was 45%. All patients presented CMD (NH-IMRangio ≥ 25) in at least one epicardial coronary artery. The left anterior descending artery (LAD) showed higher median NH-IMRangio values than left circumflex (LCx) and right coronary arteries (RCA) (44.6 vs. 31.3 vs. 36.1, respectively; p < 0.001). NH-IMRangio values differed among ventricular contractility patterns in the LAD and RCA (p = 0.0152 and 0.0189, respectively) with the highest values in the mid-ventricular + apical and mid-ventricular + basal patterns. NT-proBNP levels, but not high-sensitive cardiac troponin T (hs-cTnT), were correlated with both the degree and the extent of CMD in patients with TTS. Lower LVEF was also associated with higher NH-IMRangio values. Conclusions: CMD is highly prevalent in patients admitted for TTS and is associated with both a higher degree of systolic dysfunction and higher BNP levels, but not troponin. Full article
(This article belongs to the Special Issue Cardiac Magnetic Resonance (CMR), Coronary Computed Tomography Angiography (CCTA) and Invasive Functional Assessment in Coronary Disease)
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Review

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11 pages, 1039 KiB  
Review
Acetylcholine Use in Modern Cardiac Catheterization Laboratories: A Systematic Review
by Andrea Marrone, Rita Pavasini, Ennio Scollo, Federico Gibiino, Graziella Pompei, Serena Caglioni, Simone Biscaglia, Gianluca Campo and Matteo Tebaldi
J. Clin. Med. 2022, 11(4), 1129; https://doi.org/10.3390/jcm11041129 - 21 Feb 2022
Cited by 6 | Viewed by 3283
Abstract
Background: The use of acetylcholine for the diagnosis of vasospastic angina is recommended by international guidelines. However, its intracoronary use is still off-label due to the absence of safety studies. We aimed to perform a systematic review of the literature to identify adverse [...] Read more.
Background: The use of acetylcholine for the diagnosis of vasospastic angina is recommended by international guidelines. However, its intracoronary use is still off-label due to the absence of safety studies. We aimed to perform a systematic review of the literature to identify adverse events related to the intracoronary administration of acetylcholine for vasoreactivity testing to fill this gap. Methods and results: We conducted a systematic review of observational studies and randomized controlled trials dealing with the intracoronary administration of acetylcholine. Articles were searched in MEDLINE (PubMed) using the MeSH strategy. Three independent reviewers determined whether the studies met the inclusion and exclusion criteria. A total of 434 articles were selected. Data concerning clinical characteristics, study population, acetylcholine dosage, and adverse effects were retrieved from the articles. Overall, 71,566 patients were included, of which only 382 (0.5%) developed one adverse event, and there were no fatal events reported (0%). Conclusions: Intracoronary administration of acetylcholine in the setting of coronary spasm provocation testing is safe and plays a central role in the evaluation of coronary vasomotion disorders, making it worthy of becoming a part of clinical practice in all cardiac catheterization laboratories. Full article
(This article belongs to the Special Issue Cardiac Magnetic Resonance (CMR), Coronary Computed Tomography Angiography (CCTA) and Invasive Functional Assessment in Coronary Disease)
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11 pages, 293 KiB  
Review
Current Evidence on Long-Term Prognostic Factors in Vasospastic Angina
by Hack-Lyoung Kim and Sang-Ho Jo
J. Clin. Med. 2021, 10(18), 4270; https://doi.org/10.3390/jcm10184270 - 21 Sep 2021
Cited by 1 | Viewed by 2215
Abstract
Vasospastic angina (VSA) is characterized by a reversible spasm of the coronary arteries and is more prevalent in Asians. Vasodilators, such as calcium channel blockers, are effective in relieving coronary spasms and preventing clinical events. Therefore, the prognosis of VSA is generally known [...] Read more.
Vasospastic angina (VSA) is characterized by a reversible spasm of the coronary arteries and is more prevalent in Asians. Vasodilators, such as calcium channel blockers, are effective in relieving coronary spasms and preventing clinical events. Therefore, the prognosis of VSA is generally known to be better than for significant organic stenosis caused by atherosclerosis. However, coronary vasospasm is sometimes associated with fatal complications such as sudden death, ventricular arrhythmia, and myocardial infarction. Thus, it is very important to identify and actively treat high-risk patients to prevent VSA complications. Here, we will review clinical factors associated with long-term prognosis in patients with VSA. Full article
(This article belongs to the Special Issue Cardiac Magnetic Resonance (CMR), Coronary Computed Tomography Angiography (CCTA) and Invasive Functional Assessment in Coronary Disease)
11 pages, 1282 KiB  
Review
Coronary Microvascular Dysfunction: PET, CMR and CT Assessment
by Elisabetta Tonet, Graziella Pompei, Evelina Faragasso, Alberto Cossu, Rita Pavasini, Giulia Passarini, Matteo Tebaldi and Gianluca Campo
J. Clin. Med. 2021, 10(9), 1848; https://doi.org/10.3390/jcm10091848 - 23 Apr 2021
Cited by 28 | Viewed by 6457
Abstract
Microvascular dysfunction is responsible for chest pain in various kinds of patients, including those with obstructive coronary artery disease and persistent symptoms despite revascularization, or those with myocardial disease without coronary stenosis. Its diagnosis can be performed with an advanced imaging technique such [...] Read more.
Microvascular dysfunction is responsible for chest pain in various kinds of patients, including those with obstructive coronary artery disease and persistent symptoms despite revascularization, or those with myocardial disease without coronary stenosis. Its diagnosis can be performed with an advanced imaging technique such as positron emission tomography, which represents the gold standard for diagnosing microvascular abnormalities. In recent years, cardiovascular magnetic resonance and cardiac computed tomography have demonstrated to be emerging modalities for microcirculation assessment. The identification of microvascular disease represents a fundamental step in the characterization of patients with chest pain and no epicardial coronary disease: its identification is important to manage medical strategies and improve prognosis. The present overview summarizes the main techniques and current evidence of these advanced imaging strategies in assessing microvascular dysfunction and, if present, their relationship with invasive evaluation. Full article
(This article belongs to the Special Issue Cardiac Magnetic Resonance (CMR), Coronary Computed Tomography Angiography (CCTA) and Invasive Functional Assessment in Coronary Disease)
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