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New insights of cardiac imaging in acute chest pain.

Coronary Artery Disease (Chronic)

Prof. T. Edvarsen described the usefulness of strain imaging in non-STEMI acute coronary syndromes. Abnormal regional strain is characterized by initial stretch (early systolic lengthening), low systolic deformation and post-systolic shortening. The duration of stretch is important in detecting the presence of significant coronary artery stenosis. Abnormal global strain reflects final myocardial scar. Strain imaging can identify the patients who should be directly submitted to revascularization therapy.

Prof. Neskovic presented the information provided by intracoronary imaging tools. IVUS identifies positive artery remodelling. The addition of radiofrequency analysis makes it possible to obtain virtual histology, which, however, does not always correspond perfectly to real histology. Optical coherence tomography (OCT) identifies the different types of plaques, better detects fibrous cap disruption or erosion, precisely measures fibrous cap thickness and quantifies macrophage density. Intracoronary thrombus is detected with a sensitivity of 100%. OCT provides in vivo identification of plaque characteristics, evaluates the natural history of the disease and the mechanisms of drug related effects.

Prof. Pinto reminded us of the current ESC Guidelines and the indications for imaging techniques in stable coronary artery disease and acute coronary syndromes. Echocardiography may assist in making the diagnosis in uncertain cases and in identifying other causes of chest pain. Stress imaging is useful after the acute phase, before discharge for the detection of myocardial viability and inducible ischaemia. Comprehensive information can be obtained by cardiac MRI, which detects ischaemia, contractility and scarring. Cardiac CT with the possibility to assess fractional flow reserve can assess both the anatomy and the haemodynamic significance of coronary lesions.

Prof. Rigo described the criteria for the diagnosis of stress cardiomyopathy (Tako-Tsubo syndrome), its clinical presentation and pathophysiology. An integrated, multimodality imaging approach is useful. Several echocardiographic variables provide useful information to predict the occurrence of complications.


SessionTitle: New insights of cardiac imaging in acute chest pain.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.