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Recent Advances in Coronary Artery Disease

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 28803

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Dr. Emanuele Barbato

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Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131 Naples, Italy
Interests: coronary artery disease

Special Issue Information

Dear Colleagues,

Over the course of the recent decades, the mortality rate of coronary artery disease (CAD) has been decreasing due to improvement in the acute coronary syndrome setting. Additionally, our understanding of CAD has been constantly increasing. In particular, new tools and indices able to discern the physiological significance of epicardial coronary stenoses and the function of microcirculation are improving the indication for revascularization and medical therapy. In parallel, non-invasive alternatives are being developed to allow less invasive and more widely applicable diagnoses. The development of new interventional devices and techniques will allow the treatment of anatomically challenging stenosis, such as heavily calcified plaques. In addition, the development of interventional electrophysiology and the frequent coexistence of CAD and arrhythmias are posing management issues but provide potential for combined interventional therapies.

This Special Issue of the Journal of Clinical Medicine will cover the following important aspects of CAD:

The physiology of coronary flow: from epicardial arteries to microcirculation;
New methodologies for the assessment of epicardial atherosclerotic lesions;
New methodologies for the assessment of the microvasculature;
Novelties in anti-thrombotic therapy;
Management of patients with CAD and atrial fibrillation;
New technologies for the treatment of calcified coronary stenoses;
Novelties in myocardial ischemia assessment;
New tools for patient risk stratification.

Dr. Emanuele Barbato
Guest Editor

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Keywords

coronary physiology
coronary atherosclerosis
anti-thrombotic therapy
myocardial ischemia
ventricular arrhythmias
diagnosis
prognosis

Published Papers (11 papers)

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11 pages, 729 KiB

Open AccessArticle

Short-and-Long-Term Outcomes after Coronary Rotational Atherectomy in Patients Treated with Trans-Catheter Aortic Valve Implantation

by Mattia Lunardi, Michele Pighi, Gabriele Venturi, Paolo Alberto Del Sole, Gabriele Pesarini, Andrea Mainardi, Roberto Scarsini, Valeria Ferrero, Leonardo Gottin and Flavio Ribichini

J. Clin. Med. 2021, 10(1), 112; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10010112 - 31 Dec 2020

Cited by 5 | Viewed by 1982

Abstract

Background. Coronary artery disease (CAD) is a common finding among patients undergoing trans-catheter aortic valve implantation (TAVI), who often present severely calcified coronary lesions. Evidence is scarce about the use of rotational atherectomy (RA) in this setting, in particular regarding long-term outcome. Methods. RA was performed on severely calcified coronary lesions concomitant with TAVI in a consecutive series of patients treated between 2010 and 2020. Immediate and long-term clinical outcomes are reported. Results. A concomitant CAD (coronary stenosis visually > 50%) was observed in 402/845 (47.6%) consecutive patients undergoing TAVI at the University Hospital of Verona. Angioplasty was performed in 104 patients (12.3%). Among these, 19 patients (18.3%, 20 coronary arteries), were treated with RA after TAVI: 10 after implantation of a balloon-expandable trans-catheter valve and 9 after a self-expandable valve. All procedures were successful. Hypotension occurred in 3 patients (15.8%), with rapid recovery after the procedure; CI-AKI (contrast-induced acute kidney injury) in 3 patients (15.8%), of which two recovered within discharge. At a median follow-up of 21.5 months (Q1–3: 6–36) event free survival was 83.3%. Only one patient suffered a target vessel failure >2 years after RA. Neither stroke nor peri-procedural infarctions were detected. Conclusions. RA concomitant with TAVI was feasible and safe in patients treated with implantation of either self-expandable, or balloon-expandable trans-catheter aortic valves. Long-term clinical events related to the coronary procedure were extremely infrequent and the survival rate at median follow-up of 21.5 months was 83.3%. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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12 pages, 579 KiB

Open AccessArticle

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

by Marina Escofet Peris, Maria Teresa Alzamora, Marta Valverde, Rosa Fores, Guillem Pera, Jose Miguel Baena-Díez and Pere Toran

J. Clin. Med. 2020, 9(12), 4064; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9124064 - 16 Dec 2020

Cited by 4 | Viewed by 2030

Abstract

Background: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI). Methods: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. Results: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9. Conclusions: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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15 pages, 294 KiB

Open AccessArticle

Impact of Pulse Wave Velocity and Parameters Reflecting Android Type Fat Distribution on Left Ventricular Diastolic Dysfunction in Patients with Chronic Coronary Syndromes

by Marlena Paniczko, Małgorzata Chlabicz, Jacek Jamiołkowski, Paweł Sowa, Małgorzata Szpakowicz, Magda Łapińska, Marcin Kondraciuk, Katarzyna Ptaszyńska-Kopczyńska, Andrzej Raczkowski, Anna Szpakowicz and Karol Adam Kamiński

J. Clin. Med. 2020, 9(12), 3924; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9123924 - 03 Dec 2020

Cited by 5 | Viewed by 1619

Abstract

Background: Left ventricular diastolic dysfunction (LVDD) is caused by a decreased left ventricle relaxation and is associated with an increased risk of symptomatic heart failure (HF) and excessive mortality. Aim: To evaluate the frequency and factors related to LVDD in the population with chronic coronary syndromes (CCS). Methods: 200 patients (mean age 63.18 ± 8.12 years, 75.5% male) with CCS were included. LVDD was diagnosed based on the recent echocardiography guidelines. Results: LVDD was diagnosed in 38.5% of CCS population. From the studied factors, after adjustment for age, sex, and N-terminal pro-brain natriuretic peptide (NT-proBNP), LVDD associated positively with android/gynoid (A/G) fat mass ratio, left ventricular mass index (LVMI), and negatively with Z-score and left ventricular ejection fraction (LVEF). In stepwise backward logistic regression analysis, the strongest factors associated with LVDD were pulse wave velocity value, handgrip strength and waist to hip ratio (WHR). Conclusions: LVDD is common among CCS patients and it is associated with parameters reflecting android type fat distribution regardless of NT-proBNP and high-sensitivity troponin T concentrations. Deterioration in diastolic dysfunction is linked with increased aortic stiffness independently of age and sex. Further studies evaluating the effects of increasing physical fitness and lowering abdominal fat accumulations on LVDD in CCS patients should be considered. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

12 pages, 2244 KiB

Open AccessArticle

Association of the Hemoglobin to Serum Creatinine Ratio with In-Hospital Adverse Outcomes after Percutaneous Coronary Intervention among Non-Dialysis Patients: Insights from a Japanese Nationwide Registry (J-PCI Registry)

by Yohei Numasawa, Taku Inohara, Hideki Ishii, Kyohei Yamaji, Shun Kohsaka, Mitsuaki Sawano, Masaki Kodaira, Shiro Uemura, Kazushige Kadota, Tetsuya Amano, Masato Nakamura and Yuji Ikari

J. Clin. Med. 2020, 9(11), 3612; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9113612 - 10 Nov 2020

Cited by 6 | Viewed by 2407

Abstract

Although baseline hemoglobin and renal function are both important predictors of adverse outcomes after percutaneous coronary intervention (PCI), scarce data exist regarding the combined impact of these factors on outcomes. We sought to investigate the impact and threshold value of the hemoglobin to creatinine (Hgb/Cr) ratio, on in-hospital adverse outcomes among non-dialysis patients in a Japanese nationwide registry. We analyzed 157,978 non-dialysis patients who underwent PCI in 884 Japanese medical institutions in 2017. We studied differences in baseline characteristics and in-hospital clinical outcomes among four groups according to their quartiles of the Hgb/Cr ratios. Compared with patients with higher Hgb/Cr ratios, patients with lower ratios were older and had more comorbidities and complex coronary artery disease. Patients with lower hemoglobin and higher creatinine levels had a higher rate of in-hospital adverse outcomes including in-hospital mortality and procedural complications (defined as occurrence of cardiac tamponade, cardiogenic shock after PCI, emergency operation, or bleeding complications that required blood transfusion). On multivariate analyses, Hgb/Cr ratio was inversely associated with in-hospital mortality (odds ratio: 0.91, 95% confidence interval: 0.89–0.92; p < 0.001) and bleeding complications (odds ratio: 0.92, 95% confidence interval: 0.90–0.94; p < 0.001). Spline curve analysis demonstrated that these risks started to increase when the Hgb/Cr ratio was <15, and elevated exponentially when the ratio was <10. Hgb/Cr ratio is a simple index among non-dialysis patients and is inversely associated with in-hospital mortality and bleeding complications after PCI. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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17 pages, 7105 KiB

Open AccessArticle

Sequential Strategy Including FFR_CT Plus Stress-CTP Impacts on Management of Patients with Stable Chest Pain: The Stress-CTP RIPCORD Study

by Andrea Baggiano, Laura Fusini, Alberico Del Torto, Patrizia Vivona, Marco Guglielmo, Giuseppe Muscogiuri, Margherita Soldi, Chiara Martini, Enrico Fraschini, Mark G. Rabbat, Francesca Baessato, Gloria Cicala, Maria L. Danza, Annachiara Cavaliere, Antonella Loffreno, Vitanio Palmisano, Francesca Ricci, Giulia Rizzon, Elisabetta Tonet, Giacomo M. Viani, Saima Mushtaq, Edoardo Conte, Andrea D. Annoni, Alberto Formenti, Maria E. Mancini, Franco Fabbiocchi, Piero Montorsi, Daniela Trabattoni, Alexia Rossi, Fabio Fazzari, Nicola Gaibazzi, Daniele Andreini, Emilio M. Assanelli, Antonio L. Bartorelli, Mauro Pepi, Andrea I. Guaricci and Gianluca Pontone Show full author list Hide full author list

J. Clin. Med. 2020, 9(7), 2147; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9072147 - 08 Jul 2020

Cited by 21 | Viewed by 3417

Abstract

Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFR_CT) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFR_CT, cCTA+Stress-CTP and cCTA+FFR_CT+Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFR_CT, cCTA+Stress-CTP and cCTA+FFR_CT+Stress-CTP showed a similar rate of reclassification of cCTA findings when FFR_CT and Stress-CTP were added to cCTA. cCTA, cCTA+FFR_CT, cCTA+Stress-CTP and cCTA+FFR_CT+Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFR_CT+Stress-CTP vs cCTA and cCTA+FFR_CT: p < 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFR_CT+Stress-CTP vs cCTA and cCTA+FFR_CT: p < 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFR_CT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFR_CT+Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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10 pages, 945 KiB

Open AccessArticle

Insulin Resistance Predicts Severity of Coronary Atherosclerotic Disease in Non-Diabetic Patients

by Teresa Strisciuglio, Raffaele Izzo, Emanuele Barbato, Giuseppe Di Gioia, Iginio Colaiori, Antonella Fiordelisi, Carmine Morisco, Jozef Bartunek, Danilo Franco, Giuseppe Ammirati, Valerio Pergola, Livio Imparato, Bruno Trimarco, Giovanni Esposito and Antonio Rapacciuolo

J. Clin. Med. 2020, 9(7), 2144; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9072144 - 07 Jul 2020

Cited by 17 | Viewed by 3218

Abstract

Background: Insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) represents a predictor of coronary artery disease (CAD). However, how IR is able to impact the severity of coronary atherosclerosis in non-diabetic patients is unknown. Objectives. We investigated the relation between the IR and the extent and severity of coronary atherosclerosis in non-diabetic patients referred to coronary angiography (CA) Methods: Consecutive patients undergoing to CA for acute coronary syndromes or stable angina were analyzed. The IR was assessed by mean of the homeostasis model assessment of insulin resistance (HOMA-IR) whereas the SYNTAX score (SS) was used as index of the severity of coronary atherosclerosis Results: Overall, 126 patients were included, with a median SS of 12 (IQR 5.25–20.5). Patients were divided in four groups according to the distribution in quartiles of SS (SS1-2-3-4). A significant correlation between HOMA-IR and SS was observed, especially in women. A progressive increase of HOMA-IR was observed in parallel with the increasing severity (from SS1 to SS4) and extension (1-2-3-vessel disease) of coronary atherosclerosis. Multivariable analysis showed that the HOMA-IR was the strongest independent predictor of severe (SS4) and extensive (three-vessel disease) coronary atherosclerosis. Conclusion: Insulin resistance goes hand in hand with the extension and severity of coronary atherosclerosis in non-diabetic patients. The HOMA index is an independent predictor of three-vessel disease at CA. The HOMA index could be useful for risk stratification of CAD even in absence of T2DM. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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13 pages, 2508 KiB

Open AccessArticle

A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome

by Victor Marcos-Garces, Jose Gavara, Jose V Monmeneu, Maria P Lopez-Lereu, Nerea Perez, Cesar Rios-Navarro, Elena De Dios, David Moratal, Gema Miñana, Julio Nuñez, Francisco J Chorro and Vicente Bodi

J. Clin. Med. 2020, 9(6), 1957; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9061957 - 23 Jun 2020

Cited by 7 | Viewed by 2095

Abstract

Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age ≥ 65 years = 3 points, LVEF ≤ 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score ≥ 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts (n > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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Review

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16 pages, 612 KiB

Open AccessReview

Invasive Assessment of Coronary Microvascular Function

by Fabio Mangiacapra, Michele Mattia Viscusi, Giuseppe Verolino, Luca Paolucci, Annunziata Nusca, Rosetta Melfi, Gian Paolo Ussia and Francesco Grigioni

J. Clin. Med. 2022, 11(1), 228; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010228 - 31 Dec 2021

Cited by 18 | Viewed by 2198

Abstract

The critical role of the coronary microvascular compartment and its invasive functional assessment has become apparent in light of the significant proportion of patients presenting signs and symptoms of myocardial ischemia, despite the absence of epicardial disease, or after the adequate treatment of it. However, coronary microvascular dysfunction (CMD) represents a diagnostic challenge because of the small dimensions of the coronary microvasculature, which prevents direct angiographic visualization. Several diagnostic tools are now available for the invasive assessment of the coronary microvascular function, which, in association with the physiological indices used to investigate the epicardial department, may provide a comprehensive evaluation of the coronary circulation as a whole. Recent evidence suggests that the physiology-guided management of CMD, although apparently costly and time-consuming, may offer a net clinical benefit in terms of symptom improvement among patients with angina and ischemic heart disease. However, despite the results of several observational studies, the prognostic effect of the physiology-driven management of CMD within this population is currently a matter of debate, and therefore represents an unmet clinical need that urgently deserves further investigation. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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11 pages, 506 KiB

Open AccessReview

Evidence and Applicability of Stress Cardiovascular Magnetic Resonance in Detecting Coronary Artery Disease: State of the Art

by Anna Baritussio, Alessandra Scatteia, Santo Dellegrottaglie and Chiara Bucciarelli-Ducci

J. Clin. Med. 2021, 10(15), 3279; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153279 - 25 Jul 2021

Cited by 3 | Viewed by 1750

Abstract

Cardiovascular magnetic resonance is increasingly used in clinical practice, as it has emerged over the years as an invaluable imaging technique for diagnosis and prognosis, with clear-cut applications in managing patients with both ischemic and non-ischemic heart disease. In this review, we focus [...] Read more.

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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38 pages, 2341 KiB

Open AccessReview

Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

by Alessandro Bellis, Giuseppe Di Gioia, Ciro Mauro, Costantino Mancusi, Emanuele Barbato, Raffaele Izzo, Bruno Trimarco and Carmine Morisco

J. Clin. Med. 2021, 10(13), 2968; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10132968 - 01 Jul 2021

Cited by 15 | Viewed by 3771

Abstract

The significant reduction in ‘ischemic time’ through capillary diffusion of primary percutaneous intervention (pPCI) has rendered myocardial-ischemia reperfusion injury (MIRI) prevention a major issue in order to improve the prognosis of ST elevation myocardial infarction (STEMI) patients. In fact, while the ischemic damage increases with the severity and the duration of blood flow reduction, reperfusion injury reaches its maximum with a moderate amount of ischemic injury. MIRI leads to the development of post-STEMI left ventricular remodeling (post-STEMI LVR), thereby increasing the risk of arrhythmias and heart failure. Single pharmacological and mechanical interventions have shown some benefits, but have not satisfactorily reduced mortality. Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far. On the basis of the results of the consistent clinical studies analyzed in this review, we try to design a randomized clinical trial aimed at evaluating the effects of a reasoned multitarget therapeutic strategy on the prevention of post-STEMI LVR. In fact, we believe that the correct timing of pharmacological and mechanical intervention application, according to their specific ability to interfere with survival pathways, may significantly reduce the incidence of post-STEMI LVR and thus improve patient prognosis. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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15 pages, 975 KiB

Open AccessReview

Pathophysiology, Diagnosis, and Treatment of Patients with Concomitant Severe Aortic Stenosis and Coronary Artery Disease: A Closer Look to the Unresolved Perplexity

by Giuseppe Di Gioia, Jozef Bartunek, Tullio Tesorio, Vladan Vukcevic, Srdjan Aleksandric, Milan Dobric, Danilo Franco, Emanuele Barbato and Marko Banovic

J. Clin. Med. 2021, 10(8), 1617; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081617 - 11 Apr 2021

Cited by 10 | Viewed by 2664

Abstract

Degenerative aortic stenosis (AS) and coronary artery disease (CAD) are the most prevalent cardiovascular diseases in developed countries, and they coexist in up to 50% of patients. The pathophysiological rationale behind concomitant AS and CAD is discussed in detail in this review, together with prognostic implications. Detecting CAD in patients with AS may be challenging, as AS may mask the existence and symptoms of CAD. The safety and reliability of invasive and non-invasive physiological assessment for epicardial coronary disease are also a matter of debate. Finally, the selection and timing of optimal treatment of CAD in patients with severe AS are still unclear. Given the aging of the population, the increase in the prevalence of AS, and the ongoing paradigm shift in its treatment, controversies in the diagnosis and treatment of CAD in the setting of AS are deemed to grow in importance. In this paper, we present contemporary issues in the diagnosis and management of CAD in patients with severe AS who are transcatheter aortic valve implantation (TAVI) candidates and provide perspective on the treatment approach. Full article

(This article belongs to the Special Issue Recent Advances in Coronary Artery Disease)

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