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Bergamaschi L, Pavon AG, Angeli F, Tuttolomondo D, Belmonte M, Armillotta M, Sansonetti A, Foà A, Paolisso P, Baggiano A, Mushtaq S, De Zan G, Carriero S, Cramer MJ, Teske AJ, Broekhuizen L, van der Bilt I, Muscogiuri G, Sironi S, Leo LA, Gaibazzi N, Lovato L, Pontone G, Pizzi C, Guglielmo M. The Role of Non-Invasive Multimodality Imaging in Chronic Coronary Syndrome: Anatomical and Functional Pathways. Diagnostics (Basel) 2023; 13:2083. [PMID: 37370978 PMCID: PMC10297526 DOI: 10.3390/diagnostics13122083] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact. Currently, various guidelines and recommendations have been published about chronic coronary syndromes (CCS). According to the recent European Society of Cardiology guidelines on chronic coronary syndrome, a multimodal imaging approach is strongly recommended in the evaluation of patients with suspected CAD. Today, in the current practice, non-invasive imaging methods can assess coronary anatomy through coronary computed tomography angiography (CCTA) and/or inducible myocardial ischemia through functional stress testing (stress echocardiography, cardiac magnetic resonance imaging, single photon emission computed tomography-SPECT, or positron emission tomography-PET). However, recent trials (ISCHEMIA and REVIVED) have cast doubt on the previous conception of the management of patients with CCS, and nowadays it is essential to understand the limitations and strengths of each imaging method and, specifically, when to choose a functional approach focused on the ischemia versus a coronary anatomy-based one. Finally, the concept of a pathophysiology-driven treatment of these patients emerged as an important goal of multimodal imaging, integrating 'anatomical' and 'functional' information. The present review aims to provide an overview of non-invasive imaging modalities for the comprehensive management of CCS patients.
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Affiliation(s)
- Luca Bergamaschi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland (A.G.P.); (L.A.L.)
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland (A.G.P.); (L.A.L.)
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (F.A.); (M.A.); (A.S.); (A.F.); (C.P.)
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Domenico Tuttolomondo
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy; (D.T.); (N.G.)
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, 9300 Aalst, Belgium;
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy;
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (F.A.); (M.A.); (A.S.); (A.F.); (C.P.)
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (F.A.); (M.A.); (A.S.); (A.F.); (C.P.)
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (F.A.); (M.A.); (A.S.); (A.F.); (C.P.)
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy;
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Giulia De Zan
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (G.D.Z.); (M.-J.C.); (A.J.T.); (L.B.); (I.v.d.B.)
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Maarten-Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (G.D.Z.); (M.-J.C.); (A.J.T.); (L.B.); (I.v.d.B.)
| | - Arco J. Teske
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (G.D.Z.); (M.-J.C.); (A.J.T.); (L.B.); (I.v.d.B.)
| | - Lysette Broekhuizen
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (G.D.Z.); (M.-J.C.); (A.J.T.); (L.B.); (I.v.d.B.)
| | - Ivo van der Bilt
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (G.D.Z.); (M.-J.C.); (A.J.T.); (L.B.); (I.v.d.B.)
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (G.M.); (S.S.)
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (G.M.); (S.S.)
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland (A.G.P.); (L.A.L.)
| | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy; (D.T.); (N.G.)
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy;
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy; (F.A.); (M.A.); (A.S.); (A.F.); (C.P.)
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Marco Guglielmo
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (G.D.Z.); (M.-J.C.); (A.J.T.); (L.B.); (I.v.d.B.)
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
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