Coronary artery disease and the myocardial ischemic cascade:
Gespeichert in:
Weitere Verfasser: | |
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Format: | Buch |
Sprache: | English |
Veröffentlicht: |
Philadelphia, Pa.
Elsevier
2015
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Schriftenreihe: | Radiologic clinics of North America
53,2 |
Online-Zugang: | Inhaltsverzeichnis |
Beschreibung: | XVI S., S. 261 - 439 zahlr. Ill., graph. Darst. |
ISBN: | 9780323356657 |
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Datensatz im Suchindex
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adam_text | Titel: Coronary artery disease and the myocardial ischemic cascade
Autor: Schoepf, U. J
Jahr: 2015
Coronary Artery Disease and the Myocardial Ischemic Cascade
Contents
Preface: Coronary Artery Disease and the Myocardial Ischemic Cascade:
State-of-the-Art Computed Tomography and MR Imaging xv
U. Joseph Schoepf and James C. Carr
Imaging Coronary Artery Disease and the Myocardial Ischemic Cascade: Clinical
Principles and Scope 261
Matthias Renker, Stefan Baumann, Jeremy Rier, Ullrich Ebersberger, Stephen R. Fuller,
Nicholas I. Batalis, U. Joseph Schoepf, and Salvatore A. Chiaramida
On a subcellular level, atherogenesis is characterized by the translocation of proa-
therogenic lipoproteins into the arterial wall. An inflammatory response involving
complex repair mechanisms subsequently causes maladaptive vascular changes
resulting in coronary stenosis or occlusion. The chronology of the underlying pro-
cesses occurring from atherosclerosis to myocardial ischemia affect the selection
and interpretation of diagnostic testing. An understanding of the ischemic cascade,
atherosclerosis, coronary remodeling, plaque morphology, and their relationship to
clinical syndromes is essential in determining which diagnostic modalities are useful
in clinical practice.
Computed Tomographic Assessment of Coronary Artery Disease: State-of-the-Art
Imaging Techniques 271
Thomas G. Flohr, Carlo Nicola De Cecco, Bernhard Schmidt, Rui Wang, U. Joseph Schoepf,
and Felix G. Meinel
While coronary computed tomography (CT) angiography and more refined imaging
of the coronary anatomy have driven technical innovation in cardiac CT for the last
10 years, there is now an increasing focus on functional applications of cardiac CT,
such as evaluation of the myocardial blood supply or assessment of dynamic
myocardial perfusion. Novel techniques show promising results. This article focuses
on state-of-the-art CT imaging techniques to visualize the coronary anatomy, de-
scribes aspects of radiation dose reduction, and briefly touches on recent ap-
proaches to obtain functional information from a CT scan of the heart, in particular
dual-energy CT.
Coronary Computed Tomographic Angiography in Clinical Practice: State of the Art 287
Felix G. Meinel, Richard R. Bayer II, Peter L. Zwerner, Carlo Nicola De Cecco,
U. Joseph Schoepf, and Fabian Bamberg
In patients with stable chest pain, coronary CT angiography (CCTA) has demon-
strated high accuracy in excluding coronary artery disease and CCTA findings carry
prognostic significance for the occurrence of future cardiovascular events. Increas-
ingly, CCTA has been adopted as a triage tool in patients with acute chest pain. In
specific clinical scenarios, CCTA further represents a useful tool to exclude an
ischemic etiology in patients with cardiac arrhythmias or newly diagnosed heart
failure. Several novel techniques are currently being investigated which may extend
the ability of CCTA to characterize and quantify coronary artery plaque and assess
the hemodynamic significance of stenosis.
viii
Contents
Cardiac Computed Tomography for the Evaluation of the Acute Chest Pain Syndrome:
State of the Art 297
Christopher L. Schlett, Udo Hoffmann, Tobias Geisler, Konstantin Nikolaou, and
Fabian Bamberg
Coronary computed tomography angiography (CCTA) is recommended for the
triage of acute chest pain in patients with a low-to-intermediate likelihood for acute
coronary syndrome. Absence of coronary artery disease (CAD) confirmed by CCTA
allows rapid emergency department discharge. This article shows that CCTA-based
triage is as safe as traditional triage, reduces the hospital length of stay, and may
provide cost-effective or even cost-saving care.
Computed Tomography Imaging of Coronary Artery Plaque: Characterization and
Prognosis 307
Stefan Baumann, Matthias Renker, Felix G. Meinel, Julian L. Wichmann, Stephen R. Fuller,
Richard R. Bayer II, U. Joseph Schoepf, and Daniel H. Steinberg
The exact definition and prognostication of vulnerable plaque remain elusive, and
multiple imaging modalities aim to identify these plaques. As a noninvasive tech-
nique for the diagnosis of coronary artery disease, coronary computed tomography
angiography has become increasingly utilized, primarily in patients with an elevated
cardiovascular risk profile. Recent advances in technical methods have allowed for
improved visualization of the vessel wall and surrounding tissue, allowing for
improved characterization of vulnerable plaques by identifying features such as
low-density plaques, positive remodeling, and spotty calcification. Quantification
and qualification of these plaques may enhance the ability to predict future cardio-
vascular events.
Beyond Stenosis Detection: Computed Tomography Approaches for Determining the
Functional Relevance of Coronary Artery Disease 317
Carlo Nicola De Cecco, Akos Varga-Szemes, Felix G. Meinel, Matthias Renker, and
U. Joseph Schoepf
Coronary computed tomography angiography (CCTA) is an established imaging
technique for the noninvasive assessment of coronary arteries. However, CCTA re-
mains a morphologic technique with the same limitations as invasive coronary angi-
ography in evaluating the hemodynamic significance of coronary stenosis. Different
computed tomography (CT) techniques for the functional analysis of coronary le-
sions have recently emerged, including static and dynamic CT myocardial perfusion
imaging and CT-based fractional flow reserve and transluminal attenuation gradient
methods. These techniques hold promise for achieving a comprehensive appraisal
of anatomic and functional aspects of coronary heart disease with a single modality.
Current State of the Art Cardiovascular MR Imaging Techniques for Assessment of
Ischemic Heart Disease 335
Christopher J. Francois
Cardiac magnetic resonance (CMR) imaging is increasingly being used to evaluate
patients with known or suspected ischemic heart disease, because of its ability to
acquire images in any orientation and the wide variety of sequences available to
characterize normal and abnormal structure and function. Substantial improvements
have been made in the hardware and software used to perform CMR, resulting in
better and more consistent image quality. There has been a greater emphasis
Contents ix
recently in developing and validating quantitative CMR techniques. This article re-
views advances in CMR techniques for assessing cardiac function, myocardial
perfusion, late gadolinium enhancement, and tissue characterization with T1 and
T2 mapping sequences.
MR Imaging of the Coronary Vasculature: Imaging the Lumen, Wall, and Beyond 345
Kai Lin and James C. Carr
The characteristics of coronary artery disease are gradual thickening of the coronary
walls and narrowing of the vascular lumen by the buildup of atherosclerosis plaques.
These morphologic changes can be noninvasive^ detected by coronary magnetic
resonance (MR) imaging/MR angiography (MRA). In addition, functional changes,
such as coronary wall distensibility and flow changes, may also be evaluated with
MR imaging. However, the application of current MR imaging/MRA techniques is
limited in clinical practice because of several adverse technical and physiologic fac-
tors, such as cardiac and respiratory motion. Many technical innovations have been
adopted to address these problems from multiple aspects.
Stress Cardiac MR Imaging: The Role of Stress Functional Assessment and Perfusion
Imaging in the Evaluation of Ischemic Heart Disease 355
Saeed Al Sayari, Sebastien Kopp, and Jens Bremerich
Stress cardiac magnetic resonance imaging can provide valuable information for the
diagnosis and management of ischemic heart disease (IHD). It plays an important
role in the initial diagnosis in patients with acute chest pain, in the diagnosis of com-
plications post myocardial infarction (Ml), in the assessment of the right ventricle
after an acute Ml, to detect complications due to or after interventions, in prediction
of myocardial recovery, to detect inducible ischemia in patients with known IHD, in
differentiating ischemic from non-ischemic dilated cardiomyopathy, and in risk
stratification.
Global and Regional Functional Assessment of Ischemic Heart Disease with Cardiac MR
Imaging 369
Jeremy D. Collins
Cardiac MR imaging (CMR) combines assessment of myocardial function and tissue
characterization, and is therefore ideally suited to evaluating patients with ischemic
heart disease (IHD). This article discusses evaluation of left ventricular global func-
tion at CMR, reviewing the literature supporting global parameters in risk stratifica-
tion and assessment of treatment response in IHD. Techniques for assessment of
regional myocardial function are reviewed, and normal myocardial motion and fiber
arrangement discussed. Despite barriers to clinical adoption, integration of this
assessment into clinical routine should improve the ability to detect functional con-
sequences of early myocardial structural alterations in patients with IHD.
Late Gadolinium Enhancement Imaging in Assessment of Myocardial Viability:
Techniques and Clinical Applications 397
Laura Jimenez Juan, Andrew M. Crean, and Bernd J. Wintersperger
Assessment of myocardial viability is of ever-evolving interest in cardiovascular im-
aging, with major societies having incorporated viability imaging as class I or class
lla indications in their guidelines to better guide patient management. As with late
X
Contents
gadolinium enhancement cardiac magnetic resonance (MR), assessment of residual
myocardial viability or the extent of myocardial infarction is straightforward and this
technique may easily be combined with other cardiac MR modules. In clinical routine
functional assessment and myocardial perfusion imaging if often used in conjunction
allow for a comprehensive assessment of ischemic heart disease.
Tissue Characterization of the Myocardium: State of the Art Characterization by
Magnetic Resonance and Computed Tomography Imaging 413
Puskar Pattanayak and David A. Bleumke
Late gadolinium enhancement (LGE) is a simple, robust, well-validated method for
assessing scar in acute and chronic myocardial infarction. LGE is useful for distin-
guishing between ischemic and nonischemic cardiomyopathy. Specific LGE pat-
terns are seen in nonischemic cardiomyopathy. Patient studies using T1 mapping
have varied in study, design, and acquisition sequences. Despite the differences
in technique, a clear pattern that has been seen is that in cardiac disease postcon-
trast T1 times are shorter. Extracellular volume fraction measured with cardiac
computed tomography represents a new approach to the clinical assessment of
diffuse myocardial fibrosis by evaluating the distribution of iodinated contrast.
Index
425
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spellingShingle | Coronary artery disease and the myocardial ischemic cascade Radiologic clinics of North America |
title | Coronary artery disease and the myocardial ischemic cascade |
title_auth | Coronary artery disease and the myocardial ischemic cascade |
title_exact_search | Coronary artery disease and the myocardial ischemic cascade |
title_full | Coronary artery disease and the myocardial ischemic cascade ed. U. Joseph Schoepf ... |
title_fullStr | Coronary artery disease and the myocardial ischemic cascade ed. U. Joseph Schoepf ... |
title_full_unstemmed | Coronary artery disease and the myocardial ischemic cascade ed. U. Joseph Schoepf ... |
title_short | Coronary artery disease and the myocardial ischemic cascade |
title_sort | coronary artery disease and the myocardial ischemic cascade |
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