About this Research Topic

Background

Ischemic Chronic Coronary Syndrome (ICCS) is a term that encompasses multiple clinical conditions ranging from asymptomatic coronary artery disease (CAD) to left ventricular dysfunction and heart failure, representing worldwide one of the principal causes of morbidity and mortality. ICCS can have long, stable periods alternating with acute phases due to plaques instability and rupture which can ultimately lead to myocardial infarction and left ventricular dysfunction.

Multimodality imaging, including 2D and 3D echocardiography, cardiac computed tomography (CCT), cardiac magnetic resonance (CMR), nuclear imaging and hybrid techniques, offers a wide amount of diagnostic information including an accurate depiction of coronary anatomy, atherosclerosis, myocardial ischemia, and tissue characterization. All these data have important implications for patients’ risk assessment and management.

Echocardiography is a widely available technique that, thanks to its portability, relatively low cost, and avoidance of ionizing radiation is routinely used as a first-line test to provide a comprehensive non-invasive hemodynamic and functional assessment. Moreover, in patients with ICCS, stress echocardiography is able to identify myocardial viability and detect ischemia by evaluating wall motion abnormalities or even perfusion myocardial defects adding contrast. Speckle-tracking echocardiography is a tool that can be used for early detection of ICCS and to reduce inter-operator variability assessment.

CMR is the gold standard technique to assess biventricular dimensions and function and for the non-invasive myocardial tissue characterization. The evaluation of the presence and extent of myocardial ischemia and scar through stress CMR has shown a high rule-in power in detecting functionally significant coronary artery stenosis in patients suspected of ICCS. Moreover, Stress CMR may add significant prognostic value in predicting adverse cardiac events.

CCT, thanks to its high spatial resolution, represents currently the preferred method to assess non-invasively the coronary tree. The assessment of CAD with CCT is not only limited to coronary artery stenosis quantification but includes plaque characterization and identification of its high-risk features. Recent technology advancements with fractional flow reserve CT derived (FFR-CT) and cardiac CT perfusion (CTP) have further expanded the potentiality of CCT in the diagnostic work-up of patients, associating the functional assessment of myocardial ischemia to the anatomical depiction of CAD. Importantly, cardiac CT can be used as an alternative tool to assess ventricular function and to identify the presence and extension of myocardial scars.

Nuclear imaging has been one of the first imaging methods applied to ischemia assessment in CAD patients and still represents the most widely used test to detect myocardial ischemia. Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) represent the two main tools of nuclear imaging applied to cardiology and can be used to evaluate myocardial perfusion in a qualitative and quantitative way, left ventricular vitality and function. Hybrid cardiac imaging combining SPECT or PET with CCT data appears to offer additional diagnostic and prognostic information.

Finally, artificial intelligence (AI) algorithms applied to multimodality imaging represents a promising tool for the management of patients with suspected or established CAD.

This Research Topic aims to review the last technical advances in assessment of ICCS with cardiovascular imaging, new tools or algorithms and also current applications, to discuss the challenges that cardiovascular imagery may face.

Keywords: ischemic cardiomyopathy, coronary computed tomography angiography, stress cardiac magnetic resonance, myocardial viability, nuclear medicine

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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