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Published on: February 18, 2020
Coronary Physiology Across the Whole Spectrum of Ischemic Heart Disease
Ciro Pollio Benvenuto1,2, Luigi Cappannoli3, Andrea Viceré1
1Department of Cardiovascular Science, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.
Insights
Coronary syndromes pose significant cardiovascular risks. This review explores invasive functional assessment for diagnosing ischemia, guiding treatment, and improving prognosis in Acute Coronary Syndrome (ACS) and Chronic Coronary Syndrome (CCS).
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Acute and Chronic Coronary Syndromes (ACS/CCS) are leading causes of cardiovascular mortality.
- These syndromes involve complex structural and functional abnormalities in epicardial and microvascular coronary compartments.
- A comprehensive approach is essential to investigate the full spectrum of coronary artery disease.
Purpose of the Study:
- To review the current evidence in coronary physiology.
- To discuss the optimal application of invasive functional assessment in clinical practice.
- To address the underutilization and heterogeneity in the performance of functional assessments for ACS and CCS.
Main Methods:
- Review of existing literature on invasive functional assessment in coronary artery disease.
- Analysis of the evolution of functional assessment techniques from guiding revascularization to characterizing ischemia.
- Discussion of protocols for ischemia characterization and prognostic stratification.
Main Results:
- Invasive functional assessment has evolved into a meticulous protocol for characterizing ischemia and stratifying prognosis.
- Despite its benefits, coronary physiology is underused in clinical practice.
- There is significant heterogeneity in proposed protocols for functional assessment across different centers.
Conclusions:
- A comprehensive understanding and standardized application of coronary physiology are crucial for managing ACS and CCS.
- Further research and consensus are needed to optimize the use of functional assessment in routine clinical practice.
- Best practices for utilizing coronary physiology in diagnosing and managing coronary syndromes require further elucidation.
Abstract:
Acute and Chronic Coronary Syndromes represent two major medical challenges and are the leading cause of cardiovascular mortality and morbidity. While Chronic Coronary Syndrome (CCS) can be defined as the whole group of structural and/or functional abnormalities involving coronary arteries before and after an acute event, Acute Coronary Syndrome (ACS) encompasses the condition of acute myocardial ischemia (with or without consequent myocardial injury and troponin release) due to dynamic mechanisms such as athero-thrombosis or vasospasm. Because of this complex interplay between structural and functional mechanisms arising from both the epicardial and microvascular compartments, a comprehensive approach to fully investigate the whole spectrum of coronary disease is therefore essential. To address this issue, the invasive functional assessment has evolved through the years, from a way to guide revascularization to a meticulous protocol for characterizing ischemia-leading mechanisms and stratifying prognosis both in ACS and CCS. However, coronary physiology remains underused in clinical practice, and multiple gaps in knowledge still exist; on top of this, there is increasing heterogeneity regarding how to perform functional assessment, with different protocols proposed by various centers. The aim of this review is to summarize the evidence in the field of coronary physiology, and to discuss how and when to use it at its best.
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