Things have changed so much since I obtained my medical degreeâ€”fortunately mostly for the betterâ€”that I sometimes feel as if I should return to university to resit the same degree. I am sure that this is the case for all fields of medicine and not just for cardiology. In only a few years, the technological innovations and the close, fruitful relationship between industry and academia have created a revolution in cardiology. Cardiologists no longer require only a stethoscope to listen to the heart. Today, we can see the heart and its coronary arteries, and we can witness the heartâ€™s movements and functions with a precision that was unthinkable a few years ago. (…)
Coronary artery disease imaging
Cardiovascular disease represents the leading cause of death worldwide. Different imaging methods are available to aide in both the diagnosis of coronary artery disease and monitoring of the disease processes, including ultrasound/echocardiography, nuclear imaging, hybrid imaging, molecular imaging, and invasive imaging. Over the last few years, developments have been made not only from a technical, but also from a medical viewpoint, and these developments have been significant for the management of coronary artery disease. This review will briefly discuss the main cardiac imaging techniques for the assessment of coronary artery disease by focusing on three main areas: (i) coronary artery anatomy, lumen size, and atherosclerotic plaques; (ii) myocardial perfusion; and (iii) myocardial viability. The advancements in imaging technology have expanded the use of imaging for coronary artery disease, and it is now considered an important tool for the prevention and diagnosis of coronary artery disease and the monitoring of the different therapeutic strategies. Cardiovascular imaging has been included in the current international guidelines, demonstrating its appropriateness for the management of patients with suspected or known coronary artery disease. (…)
Coronary artery disease imaging: what is the role of magnetic resonance imaging?
Ischemic heart disease (IHD) is a global burden, and it remains the leading cause of death worldwide. Accurate assessment of the presence and extent of IHD is a crucial step in the management of this condition. Noninvasive imaging plays a vital role in the diagnosis and risk stratification of patients. Over the last decade, cardiac magnetic resonance (CMR) imaging has emerged as a very promising noninvasive imaging modality in the assessment of IHD due to its multiparametric nature, high spatial resolution, high reproducibility, and superior tissue characterization properties, all of which are reflected in a large body of evidence in the literature. CMR provides comprehensive information in the assessment of IHD, which guides the detection and differential diagnosis, assists in the clinical decision-making process, and improves risk stratification. (…)
Techniques, such as coronary computed tomography angiography (CCTA), have been instrumental for the advancements in our understanding of coronary artery disease. The advent of CCTA will significantly change the treatment approach for three types of patients. For asymptomatic, but high-risk patients, CCTA can identify the presence, extent, and content of plaque formation quickly and precisely to determine the best option for medical therapy. For patients with stable coronary artery disease, CCTA can reliably exclude epicardial stenosis to minimize the number of patients who will need to undergo invasive coronary angiography. Finally, for patients with low-risk acute coronary syndromes, the combination of high-sensitivity troponins and CCTA will safely reduce the number of subsequent outpatient procedures, which will lessen the burden on often-underfinanced health care systems. (…)
What is the role of intracoronary imaging?
Intravascular imaging modalities are used by interventional cardiologists to assess atherosclerotic plaque features and stent deployment results, overcoming some limits of coronary angiography. Optical coherence tomography, intravascular ultrasound, and near-infrared spectroscopy are the most commonly used intravascular techniques. Each technique has specific advantages and limitations that make each one appropriate for specific purposes. In the last years, offline analysis software has been developed to diagnose plaque tissue components, such as macrophages, better and improve coronary stent assessment, even in a three-dimensional view (carpet view). Although optical coherence tomography and intravascular ultrasound have been principally used for research purposes, recent evidence supports a clinical role for intracoronary imaging techniques in guiding percutaneous coronary interventions, mainly for complex procedures. (…)