Which is the optimal approach for patient evaluation in chronic coronary syndromes: anatomy or ischemia?

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Chronic coronary syndromes (CCS) affect millions globally, necessitating accurate diagnosis for effective management and improved patient outcomes.
• Non-invasive imaging is vital for detecting ischemia and guiding revascularization decisions in CCS patients.
• Coronary computed tomography angiography (CCTA) is a rapidly adopted technique providing anatomical, not functional, information.

Purpose of the Study:

• To evaluate the role of anatomical information from CCTA versus functional ischemia assessment in managing patients with suspected coronary artery disease.
• To address the clinical challenge of choosing between direct lesion visualization and detecting stress-induced myocardial dysfunction.

Main Methods:

• Review of current non-invasive imaging techniques for CCS.
• Analysis of CCTA's capabilities in visualizing coronary artery anatomy.
• Discussion of ischemia detection methods, including stress-induced abnormalities.

Main Results:

• CCTA provides detailed anatomical visualization of coronary lesions.
• Determining myocardial territory affected by ischemia or perfusion defects remains a challenge.
• The choice between anatomical and functional assessment impacts clinical decision-making.

Conclusions:

• The optimal diagnostic strategy for CCS, balancing anatomical detail from CCTA with functional ischemia assessment, requires further clarification.
• Clinician decision-making is paramount in selecting the appropriate diagnostic pathway for individual patients.