Baggiano Andrea, Italiano Gianpiero, Guglielmo Marco, Fusini Laura, Guaricci Andrea Igoren, Maragna Riccardo, Giacari Carlo Maria, Mushtaq Saima, Conte Edoardo, Annoni Andrea Daniele, Formenti Alberto, Mancini Maria Elisabetta, Andreini Daniele, Rabbat Mark, Pepi Mauro, Pontone Gianluca
Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.
Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
J Clin Med. 2022 Jan 18;11(3):477. doi: 10.3390/jcm11030477.
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.
冠状动脉疾病（CAD）是最常见的心血管疾病，具有高发病率和死亡率。历史上，疑似冠状动脉起源胸痛的患者一直通过功能测试进行评估，这些测试能够通过描绘心电图变化、心肌灌注缺损或应激状态下的室壁运动异常来检测冠状动脉阻塞的血流动力学后果。负荷超声心动图（SE）、单光子发射计算机断层扫描（SPECT）、正电子发射断层扫描（PET）和心血管磁共振（CMR）是目前可用的功能技术，技术发展提高了这些技术的诊断性能。最近，心脏计算机断层扫描血管造影（cCTA）已发展成为一种非侵入性解剖学检查方法，用于直接可视化冠状动脉血管并详细描述动脉粥样硬化负荷。心血管成像技术极大地增进了我们对CAD生理方面和心肌影响的了解。最近，在重要试验发表后，国际指南认可了这些变化，更新了适应症和推荐级别。本综述旨在总结当前标准、主要新进展和具体局限性，并提出一种用于最新临床管理的诊断算法。
