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Current Trends and Innovations in Coronary Artery Disease and Myocardial...
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Current Trends and Innovations in Coronary Artery Disease and Myocardial Ischemia

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 11143

Special Issue Editor

Dr. Edoardo Conte

E-Mail Website
Guest Editor
Ospedale Galeazzi-Sant’Ambrogio IRCCS, 20157 Milan, Italy
Interests: cardiovascular imaging; coronary artery disease; sports cardiology; pericardial dsease

Special Issue Information

Dear Colleagues,

With the advent of precision medicine, healthcare professionals can now tailor treatment plans to an individual’s risk factors, coronary anatomy and clinical conditions, optimizing therapeutic interventions for CAD and myocardial ischemia.

Moreover, non-invasive diagnostic techniques have made significant strides. Advanced imaging modalities, such as coronary CT angiography and cardiac MRI, offer highly detailed views of coronary arteries and myocardial perfusion, aiding in early and accurate disease detection.

One of the most groundbreaking developments is the rise of minimally invasive procedures and novel catheter-based techniques, such as fractional flow reserve (FFR) and intravascular imaging, which offer precise and targeted interventions for coronary arteries. Furthermore, advances in pharmacotherapy have led to the development of novel antiplatelet and antithrombotic agents, optimizing medical management for CAD patients.

Additionally, the convergence of digital health technologies and wearable devices allows for continuous monitoring and timely intervention, thereby improving patient outcomes.

The aim of this Special Issue is to gather innovative research and review papers on innovations relating coronary artery disease.

Dr. Edoardo Conte
Guest Editor

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

  • coronary artery disease
  • fractional flow reserve
  • invasive coronary angiography
  • cardiac CT
  • cardiac MRI

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Published Papers (5 papers)

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Research

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16 pages, 1710 KiB  
Article
Heart Rate Variability and Global Longitudinal Strain for Prognostic Evaluation and Recovery Assessment in Conservatively Managed Post-Myocardial Infarction Patients
by Carina Bogdan, Adrian Apostol, Viviana Mihaela Ivan, Oana Elena Sandu, Ion Petre, Oana Suciu, Luciana-Elena Marc, Felix-Mihai Maralescu and Daniel Florin Lighezan
J. Clin. Med. 2024, 13(18), 5435; https://doi.org/10.3390/jcm13185435 - 13 Sep 2024
Cited by 3 | Viewed by 1760
Abstract
Background: Heart rate variability (HRV) is the fluctuation in the time intervals between adjacent heartbeats. HRV is a measure of neurocardiac function that is produced by dynamic autonomic nervous system (ANS) processes and is a simple measure that estimates cardiac autonomic modulation. [...] Read more.
Background: Heart rate variability (HRV) is the fluctuation in the time intervals between adjacent heartbeats. HRV is a measure of neurocardiac function that is produced by dynamic autonomic nervous system (ANS) processes and is a simple measure that estimates cardiac autonomic modulation. Methods: The study included 108 patients admitted to the Coronary Intensive Care Unit with acute myocardial infarction (AMI) who did not undergo primary percutaneous transluminal coronary angioplasty (PTCA) or systemic thrombolysis and followed conservative management. All patients underwent detailed clinical, biological, and paraclinical assessments, including evaluation of HRV parameters and echocardiographic measurements. The analysis of RR variability in both time and frequency domains indicates that the negative prognosis of patients with AMI is associated with an overall imbalance in the neuro-vegetative system. The HRV parameters were acquired using continuous 24 h electrocardiogram (ECG) monitoring at a baseline, after 1 month, and 6 months. Results: Our analysis reveals correlations between alterations in HRV parameters and the increased risk of adverse events and mortality after AMI. The study found a significant improvement in HRV parameters over time, indicating better autonomic regulation post-AMI. The standard deviation of all RR intervals (SDNN) increased significantly from baseline (median 75.3 ms, IQR 48.2–100) to 1 month (median 87 ms, IQR 55.7–111) and further to 6 months (median 94.2 ms, IQR 67.6–118) (p < 0.001 for both comparisons). The root mean square of successive difference of RR (RMSSD) also showed significant increases at each time point, from baseline (median 27 ms, IQR 22–33) to 1 month (median 30.5 ms, IQR 27–38) and from 1 month to 6 months (median 35 ms, IQR 30–42) (p < 0.001 for all comparisons), indicating enhanced parasympathetic activity. Moreover, changes in HRV parameters have been associated with impaired left ventricle ejection fraction (LVEF) and global longitudinal strain (GLS), indicating a relationship between autonomic dysfunction and myocardial deformation. GLS values improved from a baseline median of −11% (IQR 5%) to −13% (IQR 4%) at 6 months (p < 0.001), reflecting better myocardial function. Conclusions: HRV parameters and cardiac performance analysis, especially using GLS, offer a solid framework for evaluating recovery and predicting adverse outcomes post-MI. Full article
(This article belongs to the Special Issue Current Trends and Innovations in Coronary Artery Disease and Myocardial Ischemia)
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12 pages, 523 KiB  
Article
Surgical Outcomes in Octogenarians with Heart Failure and Reduced Ejection Fraction following Isolated Coronary Artery Bypass Grafting—A Propensity Score Matched Analysis
by Christian Jörg Rustenbach, Rodrigo Sandoval Boburg, Medhat Radwan, Helene Haeberle, Christophe Charotte, Ilija Djordjevic, Stefanie Wendt, Tulio Caldonazo, Ibrahim Saqer, Shekhar Saha, Philipp Schnackenburg, Lina Maria Serna-Higuita, Torsten Doenst, Christian Hagl, Thorsten Wahlers, Christian Schlensak and Stefan Reichert
J. Clin. Med. 2024, 13(16), 4603; https://doi.org/10.3390/jcm13164603 - 6 Aug 2024
Viewed by 1274
Abstract
Background/Objectives: The demographic shift towards an aging population necessitates a reevaluation of surgical interventions like coronary artery bypass grafting (CABG) in octogenarians. This study aims to elucidate the outcomes of CABG in octogenarians with heart failure and reduced ejection fraction (HFrEF), a group [...] Read more.
Background/Objectives: The demographic shift towards an aging population necessitates a reevaluation of surgical interventions like coronary artery bypass grafting (CABG) in octogenarians. This study aims to elucidate the outcomes of CABG in octogenarians with heart failure and reduced ejection fraction (HFrEF), a group traditionally considered at high risk for such procedures. Methods: Conducted across four academic hospitals in Germany from 2017 to 2023, this retrospective multicenter study assessed 100 patients (50 octogenarians ≥80 years and 50 non-octogenarians <80 years) with HFrEF undergoing isolated CABG. Through propensity score matching, the study aimed to compare the incidence of major adverse cardiac and cerebrovascular events (MACCEs), as well as other clinical endpoints, between the two groups. Statistical analyses included chi-square, ANOVA, Mann–Whitney U test, Cox regression, and logistic regression, aiming to identify significant differences in outcomes. Results: The study revealed no significant difference in the combined incidence of MACCEs between octogenarians and non-octogenarians (OR: 0.790, 95% CI: 0.174–3.576, p = 0.759). Mortality rates were similar across groups (7% each, p = 1.000), as were occurrences of postoperative myocardial infarction (2% each, p = 1.000) and stroke (3% total). Secondary outcomes like delirium (17% total, no significant age group difference, p = 0.755), acute kidney injury (18% total, p = 0.664), and the need for dialysis (14% total, p = 1.000) also showed no differences between age groups. Interestingly, non-octogenarians required more packed red blood cells during their stay (p = 0.008), while other postoperative care metrics, such as hospital and ICU length of stay and ventilation hours, were comparable across groups. Conclusion: This multicenter study highlights that CABG is a viable and safe surgical option for octogenarians with HFrEF, challenging prior assumptions about the elevated risks associated with performing this procedure in older patients. The absence of significant differences in the incidence of MACCEs and other postoperative complications across age groups emphasizes the importance of careful patient selection and perioperative management. These findings advocate for a more inclusive approach to surgical treatment for octogenarians with HFrEF, suggesting that age alone should not be a determinant for CABG eligibility. This study contributes critical insights into optimizing care for a high-risk demographic, indicating a need for tailored guidelines that accommodate the aging population with complex cardiac conditions. Full article
(This article belongs to the Special Issue Current Trends and Innovations in Coronary Artery Disease and Myocardial Ischemia)
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Review

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13 pages, 1682 KiB  
Review
Coronary Artery Disease, Family History, and Screening Perspectives: An Up-to-Date Review
by Francesca Di Lenarda, Angela Balestrucci, Riccardo Terzi, Pedro Lopes, Giuseppe Ciliberti, Davide Marchetti, Matteo Schillaci, Marco Doldi, Eleonora Melotti, Angelo Ratti, Andrea Provera, Pasquale Paolisso, Daniele Andreini and Edoardo Conte
J. Clin. Med. 2024, 13(19), 5833; https://doi.org/10.3390/jcm13195833 - 30 Sep 2024
Cited by 5 | Viewed by 3125
Abstract
Family history for CAD (coronary artery disease) is an established cardiovascular (CV) risk factor and it is progressively acquiring importance in patients’ CV risk stratification. Numerous studies have demonstrated that individuals with a first-degree relative affected by CAD have a significantly higher risk [...] Read more.
Family history for CAD (coronary artery disease) is an established cardiovascular (CV) risk factor and it is progressively acquiring importance in patients’ CV risk stratification. Numerous studies have demonstrated that individuals with a first-degree relative affected by CAD have a significantly higher risk of developing the condition themselves; in particular, when CAD occurs at an early age in relatives. Indeed, recently published CCS (chronic coronary syndrome) ESC (European Society of Cardiology) guidelines include family history (FH) as a risk factor to consider when calculating pre-test risk for CAD. ESC guidelines on preventive cardiology (2021) only suggested CV risk assessment in the presence of a positive FH for CV disease, not considering it in the actual risk scores. Evidence suggests that positive anamnesis for relatives affected by CAD correlates with ACS (acute coronary syndrome) and CAD, with slight differences in relative risk as far as the degree of kinship is concerned. Genetic factors contribute to this correlation by influencing key processes that affect heart health, such as cholesterol metabolism, blood pressure regulation, and inflammatory responses. New technologies in the genetics field are increasing the availability of genome sequencing, and new polymorphism panels are being tested as predictive for CAD, objectifying familiarity. Advances in imaging techniques allow the assessment of coronary atherosclerosis and its composition, and these are acquiring strength in evidence and recommendations in ESC guidelines as a way to define coronary disease in low and low-to-intermediate risk patients and to guide medical therapy and interventional procedures. Use of these emerging tools to guide screening is likely to be extended, beyond high CV risk patients, to individuals with FH for early CAD and/or specific genetic profiles, as recent evidence in the literature is suggesting. Full article
(This article belongs to the Special Issue Current Trends and Innovations in Coronary Artery Disease and Myocardial Ischemia)
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14 pages, 3468 KiB  
Review
Myocardial Ischemia: Differentiating between Epicardial Coronary Artery Atherosclerosis, Microvascular Dysfunction and Vasospasm in the Catheterization Laboratory
by Giovanni Monizzi, Francesca Di Lenarda, Emanuele Gallinoro and Antonio Luca Bartorelli
J. Clin. Med. 2024, 13(14), 4172; https://doi.org/10.3390/jcm13144172 - 16 Jul 2024
Cited by 1 | Viewed by 1637
Abstract
Ischemic heart disease is currently the most common cause of mortality and morbidity worldwide. Although myocardial ischemia is classically determined by epicardial coronary atherosclerosis, up to 40% of patients referred for coronary angiography have no obstructive coronary artery disease (CAD). Ischemia with non-obstructive [...] Read more.
Ischemic heart disease is currently the most common cause of mortality and morbidity worldwide. Although myocardial ischemia is classically determined by epicardial coronary atherosclerosis, up to 40% of patients referred for coronary angiography have no obstructive coronary artery disease (CAD). Ischemia with non-obstructive coronary artery disease (INOCA) has typically been underestimated in the past because, until recently, its prognostic significance was not completely clear. This review aims to highlight differences and patterns in myocardial ischemia caused by epicardial obstructive CAD, coronary microvascular dysfunction (CMD) or vasomotor abnormalities and to elucidate the state of the art in correctly diagnosing these different patterns. Full article
(This article belongs to the Special Issue Current Trends and Innovations in Coronary Artery Disease and Myocardial Ischemia)
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21 pages, 1880 KiB  
Review
CT Coronary Angiography: Technical Approach and Atherosclerotic Plaque Characterization
by Serena Dell’Aversana, Raffaele Ascione, Raffaella Antonia Vitale, Fabrizia Cavaliere, Piercarmine Porcaro, Luigi Basile, Giovanni Napolitano, Marco Boccalatte, Gerolamo Sibilio, Giovanni Esposito, Anna Franzone, Giuseppe Di Costanzo, Giuseppe Muscogiuri, Sandro Sironi, Renato Cuocolo, Enrico Cavaglià, Andrea Ponsiglione and Massimo Imbriaco
J. Clin. Med. 2023, 12(24), 7615; https://doi.org/10.3390/jcm12247615 - 11 Dec 2023
Cited by 4 | Viewed by 2669
Abstract
Coronary computed tomography angiography (CCTA) currently represents a robust imaging technique for the detection, quantification and characterization of coronary atherosclerosis. However, CCTA remains a challenging task requiring both high spatial and temporal resolution to provide motion-free images of the coronary arteries. Several CCTA [...] Read more.
Coronary computed tomography angiography (CCTA) currently represents a robust imaging technique for the detection, quantification and characterization of coronary atherosclerosis. However, CCTA remains a challenging task requiring both high spatial and temporal resolution to provide motion-free images of the coronary arteries. Several CCTA features, such as low attenuation, positive remodeling, spotty calcification, napkin-ring and high pericoronary fat attenuation index have been proved as associated to high-risk plaques. This review aims to explore the role of CCTA in the characterization of high-risk atherosclerotic plaque and the recent advancements in CCTA technologies with a focus on radiomics plaque analysis. Full article
(This article belongs to the Special Issue Current Trends and Innovations in Coronary Artery Disease and Myocardial Ischemia)
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