The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes.
Luigi TassettiEnrico SfrisoFrancesco TorloneAndrea BaggianoSaima MushtaqFrancesco CannataAlberico Del TortoRoberta EspositoLaura FusiniDaniele JunodRiccardo MaragnaAlessandra VolpeNazario CarrabbaEdoardo ConteMarco GuglielmoLucia La MuraValeria PergolaRoberto PedrinelliCiro IndolfiGianfranco SinagraPasquale Perrone FilardiAndrea Igoren GuaricciGianluca Pontonenull nullPublished in: Journal of clinical medicine (2024)
Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization.
Keyphrases
- magnetic resonance
- computed tomography
- high resolution
- coronary artery disease
- left ventricular
- coronary artery
- contrast enhanced
- end stage renal disease
- percutaneous coronary intervention
- chronic kidney disease
- coronary artery bypass grafting
- magnetic resonance imaging
- image quality
- heart failure
- type diabetes
- aortic stenosis
- cardiovascular disease
- dual energy
- mass spectrometry
- patients undergoing
- aortic valve
- clinical practice
- acute coronary syndrome
- peritoneal dialysis
- fluorescence imaging
- drug induced