Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

Abstract

Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.

Galectin-3 binding protein plasma levels are associated with long-term mortality in coronary artery disease independent of plaque morphology

“…Coronary computed tomography angiography (CCTA) is an excellent non-invasive tool providing detailed insights into coronary artery plaque morphology in patients with coronary artery disease [16,17]. Other than invasive coronary angiography, CCTA may not only describe narrowing of the vessel lumen, but also give insight into plaque morphology, the degree of calcification, and vascular remodeling, which are of prognostic relevance [17,18].…”

Brain stimulation reveals crucial role of overcoming self-centeredness in self-control

“…The goals of Study 2 were to replicate the results of Study 1 and to determine the cognitive mechanisms underlying the effects of TMS over the pTPJ. Choosing a delayed or a prosocial reward involves one’s self-centered bias ( 14 , 19 ), because the ability to dissociate from one’s current state is thought to constitute a crucial and common determinant of social cognition and future thinking ( 20 ). This notion is supported by clinical studies showing that autistic children suffer not only from deficits in theory of mind and mentalizing ( 21 ) but also from impaired future thinking ( 22 ).…”

Diagnosing Left Coronary Ostial Atresia: Sometimes the Old Ways Are Best

“…These modalities produce wide ranging information on issues such as plaque composition, myocardial perfusion, and ejection fractions. 4 This is particularly relevant in adult populations (and less so in pediatrics) given the high prevalence of coronary heart disease. In fact, cardiac computed tomography angiography has been recommended as an effective screening tool to exclude obstructive lesions in lowand medium-risk individuals.…”