Seitun Sara, Mantini Cesare, Clemente Alberto, Sambuceti Virginia, Francese Giulia, Carpaneto Sara, Della Bona Roberta, Mascia Giuseppe, Cittadini Giuseppe, Porto Italo
Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy.
Echocardiography. 2025 Apr;42(4):e70117. doi: 10.1111/echo.70117.
Chronic coronary syndrome (CCS), encompassing a wide range of phenotypes and clinical scenarios, remains the leading global cause of disability and premature death. Advanced non-invasive imaging modalities, such as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR), play a pivotal role in enhancing diagnostic accuracy and guiding tailored management strategies for CCS patients. CCTA offers detailed insights into the presence, extent, and severity of coronary atherosclerotic plaques. In addition to detecting coronary stenoses, it enables the characterization of plaque phenotypes and the evaluation of additional prognostic biomarkers, such as perivascular adipose tissue (PVAT) attenuation, allowing for more comprehensive risk stratification. Recent technological advancements have further expanded CCTA's capabilities, enabling the integration of anatomical assessment with hemodynamic evaluation through non-invasive fractional flow reserve computation (FFR-CT) or stress myocardial perfusion analysis. With its superior three-dimensional spatial resolution, CCTA enhances pre-procedural planning for complex coronary revascularization, enabling the selection of optimal interventional strategies and improving patient selection. CMR is considered the gold standard for functional assessment of cardiac function, myocardial viability, quantitative flow evaluation, and tissue characterization, offering excellent soft-tissue contrast. CMR perfusion imaging can accurately assess myocardial ischemia, quantify myocardial blood flow (MBF), and detect microvascular dysfunction, thanks to its high temporal and spatial resolution with the advantage of no radiation exposure. This review highlights the evolving role of CCTA and CMR in managing patients with CCS, focusing on their current applications according to the most recent 2024 ESC guidelines, prognostic value, and recent technological advancements.
慢性冠状动脉综合征（CCS）涵盖了广泛的表型和临床情况，仍然是全球残疾和过早死亡的主要原因。先进的非侵入性成像模式，如冠状动脉计算机断层扫描血管造影（CCTA）和心脏磁共振成像（CMR），在提高诊断准确性和指导CCS患者的个性化管理策略方面发挥着关键作用。CCTA能详细洞察冠状动脉粥样硬化斑块的存在、范围和严重程度。除了检测冠状动脉狭窄外，它还能对斑块表型进行特征描述，并评估其他预后生物标志物，如血管周围脂肪组织（PVAT）衰减，从而实现更全面的风险分层。最近的技术进步进一步扩展了CCTA的功能，通过非侵入性血流储备分数计算（FFR-CT）或负荷心肌灌注分析，将解剖学评估与血流动力学评估相结合。凭借其卓越的三维空间分辨率，CCTA增强了复杂冠状动脉血运重建的术前规划，有助于选择最佳的介入策略并改善患者选择。CMR被认为是心脏功能、心肌存活、定量血流评估和组织特征功能评估的金标准，具有出色的软组织对比度。CMR灌注成像能够准确评估心肌缺血、量化心肌血流量（MBF）并检测微血管功能障碍，这得益于其高时间和空间分辨率以及无辐射暴露的优势。本综述重点介绍了CCTA和CMR在CCS患者管理中不断演变的作用，根据最新的2024年欧洲心脏病学会（ESC）指南，聚焦于它们目前的应用、预后价值和最新技术进展。
