[PDF] Physiological Assessment Of Coronary Stenoses And The Microcirculation eBook

Author : Javier Escaned
Publisher : Springer
Page : 301 pages
File Size : 37,37 MB
Release : 2017-08-10
Category : Medical
ISBN : 144715245X

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Since the introduction of coronary angiography, a key technique in understanding coronary artery disease, a number of paradigms regarding its study and interpretation have taken place. Following an emphasis on improved angiographic and subsequent intracoronary imaging techniques, functional assessment of coronary circulation has demonstrated to have major implications for diagnosis and treatment of coronary artery disease. Fractional flow reserve, a pressure derived index of stenosis severity, constitutes the best example of the current importance of physiological assessment in clinical practice. However, the acceptance of FFR by cardiologists contrasts with important voids in knowledge on the basic principles of coronary physiology and of other available techniques that, as an alternative to FFR, allow a more comprehensive assessment of coronary circulation. This is particularly noticeable in the assessment of microcirculation, an unavoidable compartment of coronary circulation that is frequently affected in acute coronary syndromes of in the presence of cardiovascular risk factors or non-coronary heart disease. A deeper understanding of the relationship between epicardial vessel and microcirculatory involvement has started with the advent of newer imaging techniques like invasive optical coherence tomography, and non-invasive CT and NMR techniques. This book aims to be an indispensable tool for clinicians and researches in the field of coronary artery disease. It provides a balanced, comprehensive review of anatomy, physiology and available techniques, discusses both the diagnosis of epicardial vessel and microcirculatory disease, the impact of different diseases at different levels of coronary circulation, and the best way to address a separate or combined assessment of different levels of coronary circulation. ​

Author : N.H. Pijls
Publisher : Springer Science & Business Media
Page : 348 pages
File Size : 12,33 MB
Release : 2013-06-29
Category : Medical
ISBN : 9401588341

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Cardiologists must answer three important questions when evaluating and treating patients with a coronary artery stenosis. As a physiologist: "What is the effect of this stenosis on coronary blood flow and myocardial function?"; as a clinician: " Is this lesion responsible for the patient's symptoms?"; and finally as an interventionalist: "Will revascularization of this artery improve the patient?" Fundamentally, the answer to these questions can be given to a large extent by measuring coronary pressure. That is the rationale of writing this book. 1. 1 Historical overview. Andreas Gruentzig and most interventional cardiologists in the early days of PTCA, had the intuitive feeling that pressure measurements could help to establish the severity of a coronary stenosis and to monitor the progress and result of a coronary intervention. At that time, measuring coronary pressure by the balloon catheter was part of a standard procedure. A residual transstenotic gradient of less than 15 mmHg was generally considered as a good result. Later, however, it turned out that measuring these (resting) gradients with balloon catheters was inaccurate an only had a limited prognostic value. Moreover, because there was no consistent theory to correlate pressure measurements to blood flow, the interest in measuring coronary pressures faded and disappeared almost completely with the introduction of new balloon catheters not intended for pressure measurement.

Author : Timothy J Watson
Publisher : Springer
Page : 338 pages
File Size : 12,22 MB
Release : 2018-07-13
Category : Medical
ISBN : 9811311145

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This book is open access under a CC BY 4.0 license. This quick-reference handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology. Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.

Author : Filippo Crea
Publisher : Springer Science & Business Media
Page : 263 pages
File Size : 21,13 MB
Release : 2013-08-15
Category : Medical
ISBN : 8847053676

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In the past two decades a number of studies have shown that abnormalities in the function and structure of coronary microcirculation can be detected in several cardiovascular diseases. On the basis of the clinical setting in which it occurs, coronary microvascular dysfunction (CMD) can be classified into four types: CMD in the absence of any other cardiac disease; CMD in myocardial diseases; CMD in obstructive epicardial coronary artery disease; and iatrogenic CMD. In some instances CMD represents an epiphenomenon, whereas in others it represents an important marker of risk or may contribute to the pathogenesis of myocardial ischemia, thus becoming a possible therapeutic target. This book provides an update on coronary physiology and a systematic assessment of microvascular abnormalities in cardiovascular diseases, in the hope that it will assist clinicians in prevention, detection and management of CMD in their everyday activity.

Author : Michitoshi Inoue
Publisher : Springer Science & Business Media
Page : 330 pages
File Size : 25,33 MB
Release : 2013-11-09
Category : Medical
ISBN : 4431683674

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Research centering on blood flow in the heart continues to hold an important position, especially since a better understanding of the subject may help reduce the incidence of coronary arterial disease and heart attacks. This book summarizes recent advances in the field; it is the product of fruitful cooperation among international scientists who met in Japan in May, 1990 to discuss the regulation of coronary blood flow.

Author : Pawel Petkow-Dimitrow
Publisher : Springer Science & Business Media
Page : 112 pages
File Size : 41,91 MB
Release : 2012-12-06
Category : Medical
ISBN : 1461511259

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Coronary flow reserve is an important functional parameter to understand the pathophysiology of coronary circulation. Coronary flow reserve measurement is used to assess epicardial coronary stenoses or to examine the integrity of microvascular circulation. An appreciation of coronary physiology is an integral part of clinical decision-making for cardiologists treating patients with coronary artery disease. The pioneering research efforts of Dr Lance Gould, who explored the relationship between the anatomic severity of a stenosis and its flow resistance (59;60) , have been transferred to clinical practice (94; 194). In the absence of stenosis in epicardial coronary artery, the coronary flow reserve may be decreased when coronary microvascular circulation is compromised by arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, or other diseases. Several techniques have been established for measuring coronary flow reserve. However, these techniques are either invasive (intracoronary Doppler flow wire), highly expensive and scarcely available (Positron Emission Tomography - PET) or semi-invasive and causing patient discomfort (transesophageal Doppler echocardiography), thus their clinical use is limited. Because of the clinical importance of coronary flow reserve there is a need for a simple, noninvasive, repeatable and inexpensive tool capable of this functional evaluation. This monograph focuses on the assessment of coronary flow reserve using transthoracic Doppler echocardiography - the technique fulfilling the above-mentioned criteria. Transthoracic Doppler echocardiography has become a popular tool evolving from a research to diagnostic technique applied in everyday practice.

Author : Yukio Maruyama
Publisher : Springer Science & Business Media
Page : 502 pages
File Size : 15,30 MB
Release : 2012-12-06
Category : Medical
ISBN : 443168249X

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Coronary circulation research is advancing at a rapid rate. Not only are inno vative techniques for studying myocardial perfusion being developed, new mechanisms related to coronary blood flow control and mechanics are also being discovered. The progress in this field justifies an update in the form of this new monograph. The book is divided into the following sections: "Measurement of Coronary Blood Flow and Assessment of Myocardial Per fusion" discusses advances in perfusion measurements in humans as well as nonradioactive microsphere methods. . "Coronary Flow Dynamics" elucidates the effect of heart contraction on coronary flow, perfusion, and reserve distribution as well as systolic-diastolic interaction. Models-a frequent topic of debate-are used to quantify hypotheses. "Models of Coronary Circulation" attempts to elucidate the concept of tissue pressure. "Regulatory Mechanisms of Coronary circulation and its Clinical Relevance": N u.merous mechanisms affecting coronary flow have been defined and studied at the level of isolated vessels and whole organs. The chapters in this section provide an in-depth analysis of a selection of these mechanisms and their inter actions. "Pathophysiology of Coronary Circulation in Ischemic Heart Disease" considers important aspects of factors which restrict perfusion of the myocardium in ischemic heart disease. An understanding these factors is of crucial importance in the management of patients. "Small Vessel Disorder in Coronary Circulation" describes circulatory flow and how it can be influenced by drugs.

Author : Javier Escaned
Publisher :
Page : 535 pages
File Size : 15,26 MB
Release : 2010
Category :
ISBN : 9782913628564

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"Coronary stenosis. Imaging, structure and physiology" has been designed as a clinically and research orientated reference for all cardiologists, physicians, cardiovascular imagers, trainees and investigators working in the field of ischemic heart disease. In the scenario of facilitated access to the coronary arteries provided by new diagnostic techniques, this book cornes to fill an empty space in the medical literature: a textbook providing a comprehensive, multifaceted analysis of atherosclerotic and non-atherosclerotic coronary stenoses, addressing multiple issues that are of key importance in invasive and non-invasive diagnostic studies of the coronary vessels. Emphasis has been placed in integrating three separate aspects: imaging, structure and physiology. The chapters are written by top experts in invasive and non-invasive diagnostics, coronary anatomy, pathology and physiology, encouraged by the editors to adress each topic from a plural perspective to facilitate knowledge sharing between their respective disciplines. An associated website provides access to the electronic edition of the book, which includes moving images and updated material. This book is an indispensable companion for all those involved in the diagnosis and treatment of ischemic heart disease. With a foreword by Morton J. Kern, MD, PhD.

Author : Allen Jeremias
Publisher : Elsevier Health Sciences
Page : 177 pages
File Size : 22,29 MB
Release : 2023-11-10
Category : Medical
ISBN : 044329481X

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Coronary Physiology in Contemporary Clinical Practice, An Issue of Cardiology Clinics