Imaging Techniques for the Assessment of Myocardial Perfusion

One of the most significant causes of heart failure is coronary heart disease and subsequent left ventricular dysfunction. The prognosis and perioperative mortality are influenced by left ventricular function, which is also an important predictor marker following revascularization. The evaluation of myocardial perfusion is of utmost importance in patients who present several symptoms before choosing cardiac catheterization as treatment. The evaluation of myocardial perfusion and myocardial viability leads to superior diagnostic and treatment algorithms, thus resulting in an important improvement in the outcomes of patients with coronary artery disease. Color Doppler myocardial imaging, single-photon emission computed tomography (SPECT), contrast perfusion echocardiography, positron emission computed tomography (PET) and magnetic resonance imaging (MRI) are currently used methods for assessing myocardial perfusion. This review aims to summarize the benefits and disadvantages of each of these techniques

Computed Tomography Assessment of Coronary Fistulas

Coronary artery fistulas, a rare anomaly, are represented by an abnormal communication between the coronary arteries and other vascular structures or cardiac chambers and, in most cases, are detected incidentally. Regularly, they do not cause important pathological changes, but if the symptoms persist, they need to be treated. The hemodynamic impact depends on the localization and size of the fistulas. Noninvasive imaging techniques, such as magnetic resonance imaging and multislice computed tomography, are widely used for the detection of coronary anomalies. The presence of symptoms (angina, dyspnea) is the primary indication for the surgical or percutaneous closure of the communications; therefore, a systematic follow-up is indicated in all cases. We present four cases of coronary artery fistulas, without important hemodynamic complications, detected by multislice computed tomography coronary angiography

Noninvasive Assessment of Coronary Arteries in Patients with Hematologic Disorders

Hematological conditions and their treatments have an increased risk of cardiovascular events, and invasive interventions have a higher risk of periprocedural complications in this group of patients. The aim of this review was to evaluate the risk of invasive interventions in patients with hematologic disorders and to underline the role of noninvasive cardiovascular screening in patients with hematological disorders such as Hodgkin and non-Hodgkin lymphoma, anemia, hemophilia, thrombocythemia, polycythemia vera, and leukemia. Based on present knowledge in the field, our opinion is that the screening of patients with hematological diseases is very important to reduce the morbidity and mortality due to cardiovascular events. Noninvasive assessments are suitable for this purpose with a significantly lower risk compared to invasive interventions

Persistent Left Superior Vena Cava Associated with Hemiazygos Vein Draining in It and Absence of Left Brachiocephalic Vein, in a Patient with Congenital Heart Defect

Persistent left superior vena cava is an anomalous vein that derives from a malfunction of obliteration of the left common cardinal vein during intrauterine life. The diagnosis can be suggested by a dilated coronary sinus as seen in echocardiography, or other imagistic methods. Due to the lack of hemodynamic impairment, and consequently with few or no symptoms, this vascular anomaly is frequently discovered incidentally. In this brief report we present the case of a 35-year-old male known with a complex congenital cardiovascular malformation that included atrial septum defect, persistent left superior vena cava and anomalous right pulmonary vein drainage in the PLSVC, diagnosed with sinoatrial block that required pacemaker implantation. Due to the patient’s medical history, investigations to decide the best approach needed for pacemaker implantation were performed, including a thoracic CT that incidentally found additional anomalies — the hemiazygos vein draining in PLSVC and the lack of the left brachiocephalic vein

Computed Tomography Biomarkers of Vulnerable Coronary Plaques

An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of the stenosis degree. Also, “high-risk plaque” and “thrombosis-prone plaque” are used as synonym terms for characterization of a vulnerable plaque. The imaging biomarkers for vulnerable coronary plaques are considered to be spotty calcifications, active remodeling, low-density atheroma and the presence of a ring-like attenuation pattern, also known as the napkin-ring sign. Computed cardiac tomography can determine the plaque composition by assessing the plaque density, which is measured in Hounsfield units (HU). The aim of this manuscript was to provide an update about the most frequently used biomarkers of vulnerability in a vulnerable plaque with the help of computed cardiac tomography

Positive Remodeling as a Biomarker of Plaque Vulnerability — at the Border Between Invasive and Noninvasive Assessment

Since the introduction of the new concepts of plaque vulnerability and patient vulnerability, many researchers have focused on different biomarkers that can represent predictors for coronary plaque instability. One of the features that characterize the vulnerable coronary plaque is positive remodeling, which can be easily identified by computed tomography angiography, a noninvasive procedure, or by other invasive methods such as intravascular ultrasound. This review aims to describe the assessment of positive remodeling as a marker of coronary plaque instability and the differences between computed tomography angiography and intravascular ultrasound in investigating this new biomarker