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Complications, Diagnosis and Treatment of Angina

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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 (20 May 2023) | Viewed by 10521

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Special Issue Editors

Dr. Giulia Elena Mandoli

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Guest Editor

Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
Interests: echocardiography; heart failure; atrial fibrillation; chronic heart failure; cardiac function; clinical cardiology; hypertension; cardiac echocardiography; acute heart failure; cardiac imaging

Dr. Monica Verdoia

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Guest Editor

Division of Cardiology, Nuovo Ospedale degli Infermi, Biella, Italy
Interests: acute coronary syndrome; thrombosis; atherosclerosis; dual antiplatelet therapy; percutaneous coronary intervention; inflammation; coronary physiology

Dr. Blazej Michalski

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Guest Editor

Department of Cardiology, Medical University of Lodz, 91-347 Lodz, Poland
Interests: echocardiography; heart failure; myocardial viability; Mitral valve; diastolic dysfunction

Dr. Tomaz Podlesnikar

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Guest Editor

Department of Cardiac Surgery, University Medical Centre Maribor, Maribor 2000, Slovenia; Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
Interests: multimodality imaging; valvular heart disease; coronary artery disease; cardiooncology; cardiovascular magnetic resonance; interventional echocardiography

Special Issue Information

Dear Colleagues,

Despite continuous improvements in medical field, ischemic heart diseases (CHD) remain the leading cause of mortality and morbidity in the industrialized world. Lifestyle, environmental factors, and genetic factors represent the main determinants for CHD and its more common manifestation, atherosclerotic epicardial coronary artery disease (CAD). However, multiple pathophysiologic mechanisms can be claimed for CHD and angina, including microvascular disease and non-obstructive coronary disease (MINOCA), thus requiring the incorporation of information from physiology, multimodality diagnostic, and therapeutic approaches for individualized decision making. The principal goals in the care of patients with CHD are to secure diagnosis, assess the extent of disease, relieve symptoms, and prevent future cardiac events. For further improvement of cardiovascular precision medicine, integrated algorithms are necessary. This Special Issue welcomes submissions in this field, addressing how innovative diagnostic and therapeutic strategies can optimize the management of patients with angina, comprising its most atypical forms. Beyond specialists from cardiology, researchers with a focus on imaging, inflammation, physiology, machine learning, or other affiliated disciplines are also invited to submit original articles or reviews in their area of expertise in order to enhance the awareness of the management of patients with angina, treating CHD and preventing its complications, also including special subpopulations such as diabetes and chronic kidney disease patients.

Dr. Giulia Elena Mandoli
Dr. Monica Verdoia
Dr. Blazej Michalski
Dr. Tomaz Podlesnikar
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

CAD
angina
pharmacological treatment
coronary physiology
tailored medicine
interventional cardiology
non-invasive strategies
prevention

Published Papers (5 papers)

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Research

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10 pages, 636 KiB

Open AccessArticle

Lipid Profile and Small Dense Low-Density Lipoprotein in Acute Coronary Syndrome Patients: Relationships to Demographic, Clinical, Angiographic, and Therapeutic Variables

by Akshyaya Pradhan, Ravninder Kuka, Pravesh Vishwakarma, Wahid Ali, Marco Alfonso Perrone, Ferdinando Iellamo, Gaurav Chaudhary, Sharad Chandra, Rishi Sethi, Sudhanshu Dwivedi, Varun Narain and R. K. Saran

J. Clin. Med. 2022, 11(22), 6846; https://doi.org/10.3390/jcm11226846 - 20 Nov 2022

Viewed by 1259

Abstract

Background: Several lines of evidence have supported small dense low-density lipoproteins (sd-LDL) as a marker of cardiovascular disease. The present study assessed the relationship between lipid profile and sd-LDL levels with demographic, clinical, angiographic, and therapeutic variables in acute coronary syndrome (ACS) patients. Methods: This was a single-centre, prospective, cross-sectional study conducted from September 2014 to September 2015. Patients with a diagnosis of ACS were included in this study. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined by direct homogenous assay and sd-LDL levels were calculated using an earlier described equation by Srisawadi et al. Results: A total of 200 patients with a diagnosis of ACS were studied. Males constituted 78% of the population cohort and almost 45% of participants were aged <45 years. Patients aged ≤45 years displayed higher mean sd-LDL levels of 30.40 ± 14.18 mg/dL versus patients aged >45 years with mean sd-LDL levels of 28.01 ± 11.58 mg/dL, but the difference was not statistically significant (p = 0.19). Females also displayed higher mean sd-LDL levels, but the difference also failed to achieve statistical significance (30.95 ± 13.44 mg/dL and 28.54 ± 12.64, respectively; p = 0.185). Diabetics had higher mean sd-LDL levels (33.64 ± 13.01 mg/dL and 28.07 ± 12.60 mg/dL; p = 0.273) whilst smokers had lower mean levels (27.21 ± 12.12 mg/dL and 30.51 ± 13.21 mg/dL, respectively; p = 0.071). However, the ratio of sd-LDL/lb-LDL (large buoyant LDL) was significantly higher in diabetics (0.48 vs. 0.39; p = 0.023). In the angiography cohort (n = 88), single-vessel disease was the most predominant overall while among patients aged >45 years, triple-vessel disease was significantly higher (p = 0.005). Similarly, the sd-LDL levels were 33.12 ± 11.13 mg/dL, 27.68 ± 9.80 mg/dL, and 31.65 ± 15.26 mg/dL among patients with single, double, and triple-vessel disease and did not differ significantly (p = 0.262). Prior statin users had significantly lower mean sd-LDL levels of 24.79 ± 12.23 mg/dL compared to statin-naïve patients with a mean sd-LDL of 30.01 ± 12.79 mg/dL (p = 0.027). Non-HDL levels were also significantly lower in prior statin users (112.83 mg/dL vs. 128.9 mg/dL; p = 0.017). Conclusion: In this cohort of ACS patients, age, sex, diabetes, smoking, and the angiographic severity of coronary artery disease had no significant impact on sd-LDL levels, while prior statin usage led to significantly lower sd-LDL levels. Diabetic patients, however, did have significantly higher sd-LDL/lb-LDL ratios. Full article

(This article belongs to the Special Issue Complications, Diagnosis and Treatment of Angina)

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9 pages, 686 KiB

Open AccessArticle

Implementation of a Night Service of Helicopter Transportation to Reduce the Time to Revascularization in STEMI Patients in a Mountainous Region: Impact on Outcomes

by Filippo Zilio, Marta Rigoni, Simone Muraglia, Marco Borghesi, Federico Zucchelli, Daniel Todaro, Michele Dallago, Giuseppe Braito, Fabrizio Damaggio, Giandomenico Nollo and Roberto Bonmassari

J. Clin. Med. 2022, 11(17), 5089; https://doi.org/10.3390/jcm11175089 - 30 Aug 2022

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Abstract

Background: Treatment delays are the most easily audited index of quality of care in the setting of ST-segment elevation myocardial infarction; among the components of ischemia time, system delay has been demonstrated to be a predictor of outcomes, and in a mountainous region it relies mostly upon helicopter rescue service. Aim: The aim of the study is to analyze the impact of the activation of helicopter rescue service for the nighttime for urgent transportation of patients on the time to revascularization and on the outcomes of STEMI patients. Methods: Data were prospectively collected in a database and retrospectively split into two different cohorts, based on the presentation date in the 18 months before, or after, the first day of implementation of the new organizational model. The patients were also split into two groups based on the place of STEMI diagnosis, either the chief town territory or the rest of the region, and retrospectively evaluated for vital status at 30 days and 2 years after index event. Results: The number of patients included was 751. For patients coming from outside Trento, an improvement in ST-segment resolution was shown (ST-segment elevation reduction >50% in 54.0% of the patients vs. 36.4%, p < 0.01). Moreover, a reduction in diagnosis-to-reperfusion median time has been demonstrated (from 105 to 97 min, p < 0.01), mainly driven by a reduction during the night shift (from 119 to 100 min, p = 0.02). With regard to 30-day and 2-year mortality, no statistically significant differences were achieved. Discussion: The organizational effort has translated into a significant reduction in the treatment delay for patients coming from outside the chief town. However, although a longer diagnosis to reperfusion time has been related to a higher mortality, a significant reduction in mortality was not demonstrated in our study. However, an improvement in ST-segment elevation resolution was shown for patients coming from outside the city of Trento, a result that could have other potential clinical benefits. Conclusions: Implementation of night flight proved to be effective in reducing the time between the diagnosis and the treatment of patients in the setting of STEMI, improving ST-segment elevation resolution, although no impact was shown on short- and long-term mortality. Full article

(This article belongs to the Special Issue Complications, Diagnosis and Treatment of Angina)

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11 pages, 4453 KiB

Open AccessEditor’s ChoiceArticle

Intravascular Lithotripsy for the Treatment of Stent Underexpansion: The Multicenter IVL-DRAGON Registry

by Wojciech Wańha, Mariusz Tomaniak, Piotr Wańczura, Jacek Bil, Rafał Januszek, Rafał Wolny, Maksymilian P. Opolski, Łukasz Kuźma, Adam Janas, Tomasz Figatowski, Paweł Gąsior, Marek Milewski, Magda Roleder-Dylewska, Łukasz Lewicki, Jan Kulczycki, Adrian Włodarczak, Brunon Tomasiewicz, Sylwia Iwańczyk, Jerzy Sacha, Łukasz Koltowski, Miłosz Dziarmaga, Miłosz Jaguszewski, Paweł Kralisz, Bartosz Olajossy, Grzegorz Sobieszek, Krzysztof Dyrbuś, Mariusz Łebek, Grzegorz Smolka, Krzysztof Reczuch, Robert J. Gil, Sławomir Dobrzycki, Piotr Kwiatkowski, Marcin Rogala, Mariusz Gąsior, Andrzej Ochała, Janusz Kochman, Adam Witkowski, Maciej Lesiak, Fabrizio D’Ascenzo, Stanisław Bartuś and Wojciech Wojakowski Show full author list Hide full author list

J. Clin. Med. 2022, 11(7), 1779; https://doi.org/10.3390/jcm11071779 - 23 Mar 2022

Cited by 22 | Viewed by 3690

Abstract

Background: Whereas the efficacy and safety of intravascular lithotripsy (IVL) have been confirmed in de novo calcified coronary lesions, little is known about its utility in treating stent underexpansion. This study aimed to investigate the impact of IVL in treating stent underexpansion. Methods and Results: Consecutive patients with stent underexpansion treated with IVL entered the multicenter IVL-Dragon Registry. The procedural success (primary efficacy endpoint) was defined as a relative stent expansion >80%. Thirty days device-oriented composite endpoint (DOCE) (defined as a composite of cardiac death, target lesion revascularization, or target vessel myocardial infarction) was the secondary endpoint. A total of 62 patients were enrolled. The primary efficacy endpoint was achieved in 72.6% of patients. Both stent underexpansion 58.5% (47.5–69.7) vs. 11.4% (5.8–20.7), p < 0.001, and the stenotic area 82.6% (72.4–90.8) vs. 21.5% (11.1–37.2), p < 0.001, measured by quantitative coronary angiography improved significantly after IVL. Intravascular imaging confirmed increased stent expansion following IVL from 37.5% (16.0–66.0) to 86.0% (69.2–90.7), p < 0.001, by optical coherence tomography and from 57.0% (31.5–77.2) to 89.0% (85.0–92.0), p = 0.002, by intravascular ultrasound. Secondary endpoint occurred in one (1.6%) patient caused by cardiac death. There was no target lesion revascularization or target vessel myocardial infarction during the 30-day follow-up. Conclusions: In this real-life, largest-to-date analysis of IVL use to manage underexpanded stent, IVL proved to be an effective and safe method for facilitating stent expansion and increasing luminal gain. Full article

(This article belongs to the Special Issue Complications, Diagnosis and Treatment of Angina)

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Review

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15 pages, 3901 KiB

Open AccessReview

Moving toward Precision Medicine in Acute Coronary Syndromes: A Multimodal Assessment of Non-Culprit Lesions

by Michele Bellino, Angelo Silverio, Luca Esposito, Francesco Paolo Cancro, Germano Junior Ferruzzi, Marco Di Maio, Antonella Rispoli, Maria Giovanna Vassallo, Francesca Maria Di Muro, Gennaro Galasso and Giuseppe De Luca

J. Clin. Med. 2023, 12(13), 4550; https://doi.org/10.3390/jcm12134550 - 7 Jul 2023

Cited by 1 | Viewed by 1593

Abstract

Patients with acute coronary syndrome and multivessel disease experience several recurrent adverse events that lead to poor outcomes. Given the complexity of treating these patients, and the extremely high risk of long-term adverse events, the assessment of non-culprit lesions becomes crucial. Recently, two trials have shown a possible clinical benefit into treat non-culprit lesions using a fraction flow reserve (FFR)-guided approach, compared to culprit-lesion-only PCI. However, the most recent FLOW Evaluation to Guide Revascularization in Multivessel ST-elevation Myocardial Infarction (FLOWER-MI) trial did not show a benefit of the use of FFR-guided PCI compared to an angiography-guided approach. Otherwise, intracoronary imaging using optical coherence tomography (OCT), intravascular ultrasound (IVUS), or near-infrared spectroscopy (NIRS) could provide both quantitative and qualitative assessments of non-culprit lesions. Different studies have shown how the characterization of coronary lesions with intracoronary imaging could lead to clinical benefits in these peculiar group of patients. Moreover, non-invasive evaluations of NCLs have begun to take ground in this context, but more insights through adequately powered and designed studies are needed. The aim of this review is to outline the available techniques, both invasive and non-invasive, for the assessment of multivessel disease in patients with STEMI, and to provide a systematic guidance on the assessment and approach to these patients. Full article

(This article belongs to the Special Issue Complications, Diagnosis and Treatment of Angina)

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12 pages, 1278 KiB

Open AccessReview

Coronary Physiology: Modern Concepts for the Guidance of Percutaneous Coronary Interventions and Medical Therapy

by Monica Verdoia and Andrea Rognoni

J. Clin. Med. 2023, 12(6), 2274; https://doi.org/10.3390/jcm12062274 - 15 Mar 2023

Cited by 1 | Viewed by 1662

Abstract

Recent evidence on ischemia, rather than coronary artery disease (CAD), representing a major determinant of outcomes, has led to a progressive shift in the management of patients with ischemic heart disease. According to most recent guidelines, myocardial revascularization strategies based on anatomical findings should be progressively abandoned in favor of functional criteria for the guidance of PCI. Thus, emerging importance has been assigned to the assessment of coronary physiology in order to determine the ischemic significance of coronary stenoses. However, despite several indexes and tools that have been developed so far, the existence of technical and clinical conditions potentially biasing the functional evaluation of the coronary tree still cause debates regarding the strategy of choice. The present review provides an overview of the available methods and the most recent acquirements for the invasive assessment of ischemia, focusing on the most widely available indexes, fractional flow reserve (FFR) and instant-wave free ratio (iFR), in addition to emerging examples, as new approaches to coronary flow reserve (CFR) and microvascular resistance, aiming at promoting the knowledge and application of those “full physiology” principles, which are generally advocated to allow a tailored treatment and the achievement of the largest prognostic benefits. Full article

(This article belongs to the Special Issue Complications, Diagnosis and Treatment of Angina)

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