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Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery...
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Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery Disease

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (25 September 2023) | Viewed by 9078

Special Issue Editors

Dr. Gábor Tamás Szabó

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Guest Editor
Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Interests: interventional cardiology; coronary physiology; acute myocardial infarction; percutaneous coronary revascularization; coronary microvascular disease; COVID-19; COVID-19 cardiac complications
Dr. Zsolt Kőszegi

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Guest Editor
Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Interests: interventional cardiology; coronary physiology; acute myocardial infarction; percutaneous coronary revascularization; coronary microvascular disease; chronic total coronary occlusion; MINOCA

Special Issue Information

Dear Colleagues,

In the past few decades, our understanding of coronary artery disease (CAD), including the hemodynamic and physiological assessment of epicardial coronary arteries and myocardial microcirculation, has developed remarkably. In particular, a great amount of evidence has been collected concerning the role of precise intracoronary invasive physiological evaluation in CAD-related decision making. Subsequent research relying on specific indices describing coronary flow and pressure has confirmed the significance of this approach in the optimization of the decision-making process. Consequently, CAD treatment results regarding safety, efficacy, and cost effectiveness have improved considerably. In line with these developments, current guidelines on coronary interventions emphasize lesion-specific, and in this term, personalized decisions before percutaneous coronary interventions—with the utilization of invasive coronary physiology. However, there are still several open questions in this field, such as identifying the best approach to find appropriate resting and/or hyperemic pressure indices for both the vessel and lesion levels. Similarly, the clinical value of Doppler and thermodilution techniques for the direct assessment of coronary and microvascular flow is also a debated field. At the same time, myocardial microvasculature has come to the forefront of clinical research in order to develop new patient-specific therapeutical options, especially in cases with evidence of myocardial ischemia without obstructive epicardial lesion.

In the light of the above advances in personalized evaluation as well as the management of CAD, in this Special Issue, we aim to focus on coronary physiology.

This Special Issue intends to cover the following important aspects:

  • Coronary physiology and coronary flow, indices characterizing epicardial coronary arteries and microcirculation;
  • New methodologies for the assessment of epicardial or microvascular physiology;
  • Clinical application of coronary physiology modalities in specific patient populations, including ACS, CCS, MINOCA, CAD with comorbidities, COVID-19 cases and complications, and post-COVID-19 and long-COVID-19 syndromes;
  • Personalized treatment strategies, guided by invasive physiologic assessment;
  • Image-based physiological assessment.

Dr. Gábor Tamás Szabó
Dr. Zsolt Kőszegi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coronary physiology
  • personalized invasive therapy in coronary artery disease
  • myocardial microcirculation
  • coronary pressure and flow

Published Papers (6 papers)

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Editorial

Jump to: Research

4 pages, 186 KiB  
Editorial
Pressure Never Lies, but It Should Be Interpreted Thoughtfully: The Role of Hydrostatic Pressure in Coronary Physiology
by Zsolt Kőszegi and Gábor Tamás Szabó
J. Pers. Med. 2024, 14(3), 307; https://doi.org/10.3390/jpm14030307 - 14 Mar 2024
Viewed by 606
Abstract
Personalized medicine shows promise for the management of patients with coronary artery disease (CAD) [...] Full article
(This article belongs to the Special Issue Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery Disease)

Research

Jump to: Editorial

12 pages, 1388 KiB  
Article
Functional Assessment of Long-Term Microvascular Cardiac Allograft Vasculopathy
by Noemi Bora, Orsolya Balogh, Tamás Ferenci and Zsolt Piroth
J. Pers. Med. 2023, 13(12), 1686; https://doi.org/10.3390/jpm13121686 - 05 Dec 2023
Viewed by 657
Abstract
Background: Cardiac allograft vasculopathy (CAV) is a leading cause of death and retransplantation following heart transplantation (HTX). Surveillance angiography performed yearly is indicated for the early detection of the disease, but it remains of limited sensitivity. Methods: We performed bolus thermodilution-based coronary flow [...] Read more.
Background: Cardiac allograft vasculopathy (CAV) is a leading cause of death and retransplantation following heart transplantation (HTX). Surveillance angiography performed yearly is indicated for the early detection of the disease, but it remains of limited sensitivity. Methods: We performed bolus thermodilution-based coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) and fractional flow reserve (FFR) measurements in HTX patients undergoing yearly surveillance coronary angiography without overt CAV. Results: In total, 27 HTX patients were included who had 52 CFR, IMR, and FFR measurements at a mean of 43 months after HTX. Only five measurements were performed in the first year. CFR decreased significantly by 0.13 every year (p = 0.04) and IMR tended to increase by 0.98 every year (p = 0.051), whereas FFR did not change (p = 0.161) and remained well above 0.80 over time. After one year, CFR decreased significantly (p = 0.022) and IMR increased significantly (p = 0.015), whereas FFR remained unchanged (p = 0.72). Conclusions: The functional status of the epicardial coronary arteries of transplanted hearts did not deteriorate over time. On the contrary, a significant decrease in CFR was noted. In view of the increasing IMR, this is caused by the deterioration of the function of microvasculature. CFR and IMR measurements may provide an early opportunity to diagnose CAV. Full article
(This article belongs to the Special Issue Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery Disease)
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10 pages, 1697 KiB  
Article
Atrial Fibrillation Related Coronary Embolism: Diagnosis in the Focus
by László Balogh, Péter Óvári, Christopher Uwaafo Ugbodaga and Zoltán Csanádi
J. Pers. Med. 2023, 13(5), 780; https://doi.org/10.3390/jpm13050780 - 30 Apr 2023
Cited by 1 | Viewed by 1216
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in myocardial infarction (MI). AF can be caused by ischemia, and MI can be caused by AF. Additionally, 4–5% of MI cases are related to coronary embolism (CE), and one-third of cases are attributed to [...] Read more.
Atrial fibrillation (AF) is the most common arrhythmia in myocardial infarction (MI). AF can be caused by ischemia, and MI can be caused by AF. Additionally, 4–5% of MI cases are related to coronary embolism (CE), and one-third of cases are attributed to AF. Our aim was to investigate the prevalence of AF-related CE cases among 3 consecutive years of STEMI cases. We also aimed to reveal the diagnostic accuracy of the Shibata criteria scoring system and the role of thrombus aspiration. Among 1181 STEMI patients, 157 had AF (13.2%). By using the Shibata’s diagnostic criteria, 10 cases were classified as ‘definitive’ and 31 as ‘probable’ CE. After re-evaluation, a further five cases were classified as ‘definitive’. Further analysis of the 15 CE cases revealed that CE was more prevalent in patients with previously known (n = 10) compared to those with new-onset (n = 5) AF (16.7% vs. 5.1%, p = 0.024). A PubMed search was performed, and 40 AF-related cases were found where the Shibata’s criteria could be applied. Further, 31 cases could be classified as ‘definitive’, 4 as ‘probable’ and, in 5 cases, the embolic origin could be excluded. In 40% of reported cases and in 47% of our cases, thrombus aspiration helped in diagnosis. Full article
(This article belongs to the Special Issue Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery Disease)
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9 pages, 5372 KiB  
Article
Peri-Interventional Triple Therapy with Dabigatran Modifies Vasomotion after Bare-Metal Stent Implantation in a Pig Coronary Artery Model
by Rayyan Hemetsberger, Serdar Farhan, Dominika Lukovic, Katrin Zlabinger, Judit Hajagos-Toth, Judit Bota, Hector M. Garcia-Garcia, Cihan Ay, Eslam Samaha, Robert Gaspar, Rita Garamvölgyi, Kurt Huber, Andreas Spannbauer and Mariann Gyöngyösi
J. Pers. Med. 2023, 13(2), 280; https://doi.org/10.3390/jpm13020280 - 31 Jan 2023
Viewed by 1409
Abstract
(1) Background: Coronary artery stenting leads to local inflammation, disturbs vasomotion, and slows endothelialization, increasing vascular thrombus risk. We used a pig stenting coronary artery model to assess how peri-interventional triple therapy with dabigatran ameliorates these effects. (2) Methods: In a total of [...] Read more.
(1) Background: Coronary artery stenting leads to local inflammation, disturbs vasomotion, and slows endothelialization, increasing vascular thrombus risk. We used a pig stenting coronary artery model to assess how peri-interventional triple therapy with dabigatran ameliorates these effects. (2) Methods: In a total of 28 pigs bare-metal stents were implanted. Four days before the percutaneous coronary intervention (PCI), we started 16 of the animals on dabigatran, maintained through 4 days after the procedure. As controls, the remaining 12 pigs received no therapy. In both groups, dual antiplatelet therapy (DAPT) (clopidogrel, 75 mg plus aspirin, 100 mg) was administered until animals were euthanized. Just after the PCI and on day 3 after the procedure, we performed optical coherence tomography (OCT) in eight animals in the dabigatran group and four controls and euthanized them. We followed the eight remaining animals in each group with OCT and angiography for one month before euthanizing them and performed in vitro myometry and histology on harvested coronary arteries from all animals. (3) Results: The dabigatran group showed a significantly increased vasoconstriction at 3 days after PCI (10.97 ± 3.85 mN vs. 7.32 ± 5.41 mN, p = 0.03), but we found no differences between endothelium-dependent and -independent vasodilatation. We also found no group differences in OCT, quantitative angiography, or histomorphometry findings. (4) Conclusions: Starting a short course of dabigatran just before PCI and continuing for a 3-day window along with usual post-PCI DAPT is associated with enhanced vasoconstriction after bare-metal stent implantation without reducing neointimal formation at one month. Full article
(This article belongs to the Special Issue Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery Disease)
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13 pages, 2083 KiB  
Article
In Vivo Validation of a Novel Computational Approach to Assess Microcirculatory Resistance Based on a Single Angiographic View
by Yongzhen Fan, Simone Fezzi, Pengcheng Sun, Nan Ding, Xiaohui Li, Xiaorong Hu, Shuang Wang, William Wijns, Zhibing Lu and Shengxian Tu
J. Pers. Med. 2022, 12(11), 1798; https://doi.org/10.3390/jpm12111798 - 31 Oct 2022
Cited by 15 | Viewed by 1936
Abstract
(1) Background: In spite of the undeniable clinical value of the index of microvascular resistance (IMR) in assessing the status of coronary microcirculation, its use globally remains very low. The aim of this study was to validate the novel single-view, pressure-wire- and adenosine-free [...] Read more.
(1) Background: In spite of the undeniable clinical value of the index of microvascular resistance (IMR) in assessing the status of coronary microcirculation, its use globally remains very low. The aim of this study was to validate the novel single-view, pressure-wire- and adenosine-free angiographic microvascular resistance (AMR) index, having the invasive wire-based IMR as a reference standard. (2) Methods: one hundred and sixty-three patients (257 vessels) were investigated with pressure wire-based IMR. Microvascular dysfunction (CMD) was defined by IMR ≥ 25. AMR was independently computed from the diagnostic coronary angiography in a blinded fashion. (3) Results: AMR demonstrated a good correlation (r = 0.83, p < 0.001) and diagnostic performance (AUC 0.94; 95% CI: 0.91 to 0.97) compared with wire-based IMR. The best cutoff value for AMR in determining IMR ≥ 25 was 2.5 mmHg*s/cm. The overall diagnostic accuracy of AMR was 87.2% (95% CI: 83.0% to 91.3%), with a sensitivity of 93.5% (95% CI: 87.0% to 97.3%), a specificity of 82.7% (95% CI: 75.6% to 88.4%), a positive predictive value of 79.4% (95% CI: 71.2% to 86.1%) and a negative predictive value of 94.7% (95% CI: 89.3% to 97.8%). No difference in terms of CMD rate was described among different clinical presentations. (4) Conclusions: AMR derived solely from a single angiographic view is a feasible computational alternative to pressure wire-based IMR, with good diagnostic accuracy in assessing CMD. Full article
(This article belongs to the Special Issue Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery Disease)
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13 pages, 2070 KiB  
Article
Pressure- and 3D-Derived Coronary Flow Reserve with Hydrostatic Pressure Correction: Comparison with Intracoronary Doppler Measurements
by Balázs Tar, András Ágoston, Áron Üveges, Gábor Tamás Szabó, Tibor Szűk, András Komócsi, Dániel Czuriga, Benjamin Csippa, György Paál and Zsolt Kőszegi
J. Pers. Med. 2022, 12(5), 780; https://doi.org/10.3390/jpm12050780 - 12 May 2022
Cited by 4 | Viewed by 2214
Abstract
Purpose: To develop a method of coronary flow reserve (CFR) calculation derived from three-dimensional (3D) coronary angiographic parameters and intracoronary pressure data during fractional flow reserve (FFR) measurement. Methods: Altogether 19 coronary arteries of 16 native and 3 stented vessels were reconstructed in [...] Read more.
Purpose: To develop a method of coronary flow reserve (CFR) calculation derived from three-dimensional (3D) coronary angiographic parameters and intracoronary pressure data during fractional flow reserve (FFR) measurement. Methods: Altogether 19 coronary arteries of 16 native and 3 stented vessels were reconstructed in 3D. The measured distal intracoronary pressures were corrected to the hydrostatic pressure based on the height differences between the levels of the vessel orifice and the sensor position. Classical fluid dynamic equations were applied to calculate the flow during the resting state and vasodilatation based on morphological data and intracoronary pressure values. 3D-derived coronary flow reserve (CFRp-3D) was defined as the ratio between the calculated hyperemic and the resting flow and was compared to the CFR values simultaneously measured by the Doppler sensor (CFRDoppler). Results: Haemodynamic calculations using the distal coronary pressures corrected for hydrostatic pressures showed a strong correlation between the individual CFRp-3D values and the CFRDoppler measurements (r = 0.89, p < 0.0001). Hydrostatic pressure correction increased the specificity of the method from 46.1% to 92.3% for predicting an abnormal CFRDoppler < 2. Conclusions: CFRp-3D calculation with hydrostatic pressure correction during FFR measurement facilitates a comprehensive hemodynamic assessment, supporting the complex evaluation of macro-and microvascular coronary artery disease. Full article
(This article belongs to the Special Issue Applied Invasive Coronary Physiology for Tailored Treatment of Coronary Artery Disease)
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