Coronary Imaging And Physiology

This book is intended as a guide for all cardiologists who are interested in coronary imaging and physiology, a sound understanding of which is vital for the optimal performance of appropriate coronary interventions. The basics of each relevant modality are presented, with clear explanation of clinical utility and evaluation of the evidence regarding clinical outcomes. All technical methods are described in detail, and the text is complemented by numerous helpful tables and illustrations. The effectiveness of intravascular coronary imaging in improving clinical outcomes is proven, and it is widely used for this purpose. Two modalities for intravascular coronary imaging are available in clinical practice: intravascular ultrasound (IVUS) and optical coherence tomography (OCT). For coronary physiology, the pressure wire-derived fractional flow reserve (FFR) provides information on the functional status of coronary trees. This technique and its clinical applications receive particular attention in the book, which also looks beyond FFR to FFR-CT, a method using computational fluid dynamics, and to invasive assessment of the microcirculation.

​Since the introduction of coronary angiography, a key technique in understanding coronary artery disease, a number of paradigms regarding its study and interpretation have taken place. Following an emphasis on improved angiographic and subsequent intracoronary imaging techniques, functional assessment of coronary circulation has demonstrated to have major implications for diagnosis and treatment of coronary artery disease. Fractional flow reserve, a pressure derived index of stenosis severity, constitutes the best example of the current importance of physiological assessment in clinical practice. However, the acceptance of FFR by cardiologists contrasts with important voids in knowledge on the basic principles of coronary physiology and of other available techniques that, as an alternative to FFR, allow a more comprehensive assessment of coronary circulation. This is particularly noticeable in the assessment of microcirculation, an unavoidable compartment of coronary circulation that is frequently affected in acute coronary syndromes of in the presence of cardiovascular risk factors or non-coronary heart disease. A deeper understanding of the relationship between epicardial vessel and microcirculatory involvement has started with the advent of newer imaging techniques like invasive optical coherence tomography, and non-invasive CT and NMR techniques. This book aims to be an indispensable tool for clinicians and researches in the field of coronary artery disease. It provides a balanced, comprehensive review of anatomy, physiology and available techniques, discusses both the diagnosis of epicardial vessel and microcirculatory disease, the impact of different diseases at different levels of coronary circulation, and the best way to address a separate or combined assessment of different levels of coronary circulation. ​

Coronary Physiology in Contemporary Clinical Practice, An Issue of Cardiology Clinics

Cardiovascular nuclear medicine emerged 15 years ago as a new noninvasive technique for the detection of human cardiac disease. It arised from the fields of nuclear medicine and cardiology and the cooperation of both specialties has been very productive. At present, nuclear cardiology techniques belong to the routine armamentarium of the clinical cardiologist. Results obtained by perfusion markers, metabolic tracers, and radionuclide angiography have shown to have important impact on patient management. Although exercise electrocardiography and echocar diography yield the large bulk of necessary data in the cardiac patient, nuclear cardiology provides important data that go far beyond the results obtained by the standard procedures. Magnetic resonance imaging is a relative newcomer in cardio logy and has still to prove its value in clinical cardiology . Yet, initial results have been encouraging both in congenital heart disease and in coronary artery disease. This book is based on 16 review publications that have been written throughout the period of 1985 till present time. Most chapters have been published in the period 1989 until 1991; the preceding review papers have been updated as much as possible. Furthermore, Chapter 15 entitled" What's new in cardiac imaging" has been espe cially written for this book. The Chapters 9, 11 and 13 have been recently written and have not been published yet.

"Coronary stenosis. Imaging, structure and physiology" has been designed as a clinically and research orientated reference for all cardiologists, physicians, cardiovascular imagers, trainees and investigators working in the field of ischemic heart disease. In the scenario of facilitated access to the coronary arteries provided by new diagnostic techniques, this book cornes to fill an empty space in the medical literature: a textbook providing a comprehensive, multifaceted analysis of atherosclerotic and non-atherosclerotic coronary stenoses, addressing multiple issues that are of key importance in invasive and non-invasive diagnostic studies of the coronary vessels. Emphasis has been placed in integrating three separate aspects: imaging, structure and physiology. The chapters are written by top experts in invasive and non-invasive diagnostics, coronary anatomy, pathology and physiology, encouraged by the editors to adress each topic from a plural perspective to facilitate knowledge sharing between their respective disciplines. An associated website provides access to the electronic edition of the book, which includes moving images and updated material. This book is an indispensable companion for all those involved in the diagnosis and treatment of ischemic heart disease. With a foreword by Morton J. Kern, MD, PhD.

Research centering on blood flow in the heart continues to hold an important position, especially since a better understanding of the subject may help reduce the incidence of coronary arterial disease and heart attacks. This book summarizes recent advances in the field; it is the product of fruitful cooperation among international scientists who met in Japan in May, 1990 to discuss the regulation of coronary blood flow.

Cardiac arrhythmias are a major cause of death (7 million cases annually worldwide; 400,000 in the U.S. alone) and disability. Yet, a noninvasive imaging modality to identify patients at risk, provide accurate diagnosis and guide therapy is not yet available in clinical practice. Nevertheless, there are various applications of electrophysiologic imaging in humans from ECG/CT reconstructions, MRI to tissue Doppler investigations that provide supplimentary diagnostic data to the cardiologist. EP laboratories are experiencing an increase in volume, for both diagnostic and interventional electrophysiology studies, including mapping, ablation, and pacemaker implants. The equipment requirements for these procedures are stringent, include positioning capabilities, and dose management. This book is designed to review all of the current imaging methodologies that assist in diagnosis within the electrophysiology department.