Coronary Vasomotion Abnormalities

This book reviews the latest findings on epicardial coronary spasm and coronary microvascular dysfunction (CMD), important diseases for understanding coronary artery vasomotion abnormalities. The book chiefly consists of two major parts, each of which explores the epidemiology, pathophysiology, diagnosis and treatment of the diseases. The chapters present a range of experimental and clinical studies, including the editor’s life’s work on coronary spasm; how Rho-kinase activation plays an important role in connection with the disease; how chronic adventitial inflammation is a central pathophysiology of the spasm; the importance of Rho-kinase activation in the pathogenesis of CMD; how epicardial spasm and CMD frequently co-exist; and much more. Coronary Vasomotion Abnormalities will help practicing cardiologists, cardiac surgeons, vascular biologists and radiologists understand the latest issues concerning the clinical, interventional, and surgical management of these conditions, and offer these readers valuable insights into the effective treatment of microvascular angina.

In the past two decades a number of studies have shown that abnormalities in the function and structure of coronary microcirculation can be detected in several cardiovascular diseases. On the basis of the clinical setting in which it occurs, coronary microvascular dysfunction (CMD) can be classified into four types: CMD in the absence of any other cardiac disease; CMD in myocardial diseases; CMD in obstructive epicardial coronary artery disease; and iatrogenic CMD. In some instances CMD represents an epiphenomenon, whereas in others it represents an important marker of risk or may contribute to the pathogenesis of myocardial ischemia, thus becoming a possible therapeutic target. This book provides an update on coronary physiology and a systematic assessment of microvascular abnormalities in cardiovascular diseases, in the hope that it will assist clinicians in prevention, detection and management of CMD in their everyday activity.

Endothelium and Cardiovascular Diseases: Vascular Biology and Clinical Syndromes provides an in-depth examination of the role of endothelium and endothelial dysfunction in normal vascular function, and in a broad spectrum of clinical syndromes, from atherosclerosis, to cognitive disturbances and eclampsia. The endothelium is a major participant in the pathophysiology of diseases, such as atherosclerosis, diabetes and hypertension, and these entities are responsible for the largest part of cardiovascular mortality and morbidly. Over the last decade major new discoveries and concepts involving the endothelium have come to light. This important reference collects this data in an easy to reference resource. Written by known experts, and covering all aspects of endothelial function in health and disease, this reference represents an assembly of recent knowledge that is essential to both basic investigators and clinicians. Provides a complete overview of endothelial function in health and diseases, along with an assessment of new information Includes coverage of groundbreaking areas, including the artificial LDL particle, the development of a new anti-erectile dysfunction agent, a vaccine for atherosclerosis, coronary calcification associated with red wine, and the interplay of endoplasmic reticulum/oxidative stress Explores the genetic features of endothelium and the interaction between basic knowledge and clinical syndromes

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.

This book is a comprehensive and richly-illustrated guide to cardiac CT, its current state, applications, and future directions. While the first edition of this text focused on what was then a novel instrument looking for application, this edition comes at a time where a wealth of guideline-driven, robust, and beneficial clinical applications have evolved that are enabled by an enormous and ever growing field of technology. Accordingly, the focus of the text has shifted from a technology-centric to a more patient-centric appraisal. While the specifications and capabilities of the CT system itself remain front and center as the basis for diagnostic success, much of the benefit derived from cardiac CT today comes from avant-garde technologies enabling enhanced visualization, quantitative imaging, and functional assessment, along with exciting deep learning, and artificial intelligence applications. Cardiac CT is no longer a mere tool for non-invasive coronary artery stenosis detection in the chest pain diagnostic algorithms; cardiac CT has proven its value for uses as diverse as personalized cardiovascular risk stratification, prediction, and management, diagnosing lesion-specific ischemia, guiding minimally invasive structural heart disease therapy, and planning cardiovascular surgery, among many others. This second edition is an authoritative guide and reference for both novices and experts in the medical imaging sciences who have an interest in cardiac CT.

This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.

​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. ​