New avenues for the assessment of stable ischemic heart disease
Peter Ong1, Johanna McChord2, Valeria Martínez Pereyra2
1Department of Cardiology and Angiology, Robert Bosch Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany. Peter.Ong@rbk.de.
Insights
Diagnosing myocardial ischemia requires evaluating both epicardial and microvascular causes. Advanced noninvasive imaging and invasive coronary function testing are crucial for accurate patient management and future treatment development.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Myocardial ischemia presents complex challenges due to overlapping epicardial and microvascular causes.
- Current diagnostic tools for myocardial ischemia are underutilized in precision medicine.
- Effective management strategies are hindered by the multifaceted nature of the condition.
Purpose of the Study:
- To review current and emerging diagnostic modalities for myocardial ischemia.
- To highlight the importance of comprehensive evaluation including epicardial and microvascular assessments.
- To discuss the implications for patient management and future therapeutic development.
Main Methods:
- Review of noninvasive imaging techniques, including quantitative perfusion cardiac magnetic resonance imaging (CMR) and stress perfusion computed tomography (CT).
- Discussion of invasive evaluation methods, focusing on coronary vasomotor function testing (coronary spasm, coronary flow reserve, microvascular resistance).
- Analysis of functional and structural mechanisms contributing to myocardial ischemia.
Main Results:
- Emerging noninvasive techniques like quantitative perfusion CMR and photon-counting CT show promise for assessing stable angina.
- Invasive evaluation should extend beyond epicardial disease to include coronary vasomotor function.
- Accurate diagnosis necessitates a comprehensive approach integrating various assessment tools.
Conclusions:
- Comprehensive diagnostic evaluation is essential for optimal patient management of myocardial ischemia.
- Advancements in noninvasive and invasive techniques are paving the way for new diagnostic standards.
- Future research should focus on developing novel treatment options informed by accurate ischemia assessment.
Abstract:
Myocardial ischemia is a complex condition which may result from epicardial and/or microvascular causes involving functional and structural mechanisms. These mechanisms may overlap in a given patient illustrating the difficulties for appropriate management. Assessment of myocardial ischemia can be performed using noninvasive and invasive tools. However, despite living in the era of individualized precision medicine, these tools are not yet used in a broader fashion. Emerging noninvasive techniques such as quantitative perfusion cardiac magnetic resonance imaging (CMR) and stress perfusion computed tomography (CT) or photon-counting CT techniques may contribute to new standards in the assessment of stable angina patients. Invasive evaluation of myocardial ischemia should not only focus on hemodynamically relevant epicardial disease but also involve coronary vasomotor function testing (coronary spasm, coronary flow reserve, and microvascular resistance) where appropriate. Optimal patient management will depend on accurate and comprehensive diagnostic evaluation of myocardial ischemia and development of new treatment options in the future.
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