Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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4 Techniques for Cardiovascular System Disorders
4 Techniques for Cardiovascular System Disorders
Pages 73-98
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From page 73... ...
For some individuals who are physically capable of exercise, the cardiologist may prescribe activity restriction because of a risk of sudden life-threatening arrhythmia or other physical collapse during exertion, such as can occur with some inherited genetic heart diseases, advanced hypertrophic cardiomyopathy, or critical aortic stenosis (NASEM, 2019)
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From page 74... ...
Also within nuclear cardiology, advances in cardiac positron emission tomography (PET) include enhanced diagnostic accuracy over c ardiac SPECT; the ability to evaluate coronary blood flow and coronary flow reserve (CFR)
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From page 75... ...
These advances have substantially improved diagnostic accuracy for numerous cardiovascular conditions and are facilitating the use of novel and effective therapeutic approaches to reduce the burden of cardio vascular disease. Beyond this, the continued application, combination, and refinement of these techniques are expected to broaden our understanding of cardiovascular disease pathophysiology across gender and racially diverse populations, including, for example, the importance of nonobstructive atherosclerosis and coronary microvascular dysfunction in the morbidity and mortality of patients with ischemic heart disease.
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From page 76... ...
provides additional relevant information about these tests and others for selected cardiac and cardiovascular assessments. IMAGING TECHNIQUES As described in this section, advances in imaging technology have improved the precision of diagnoses involving cardiovascular conditions.
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From page 77... ...
(c) Examples of specific impairments that can be more accurately assessed by echocardiography include pericardial effusion, ven tricular hypertrophy, ventricular dilation, ventricular wall motion abnormalities, thrombi, mitral stenosis, aortic stenosis, mitral valve prolapse, congenital heart disease, and traumatic heart dis ease (Mansi, 2020)
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From page 78... ...
. A "normal" ejection fraction is estimated to be between 50 and 70 percent; a measurement below 40 percent may be evidence of heart failure or cardiomyopathy (AHA, 2023)
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From page 79... ...
. MPI and stress testing examine heart blood flow during rest and exertion to assess the heart's structure and function in patients with known or suspected coronary artery disease.
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From page 80... ...
(f) Earlier techniques for diagnosing myocardial ischemia from sus pected coronary artery disease were limited by their lower diagnostic quality and higher radiation exposure from thallium-201 perfusion scans or by invasive catheter-based approaches.
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From page 81... ...
; and (3) the ability to quantify myocardial blood flow and coronary flow reserve to diagnose myocardial ischemia and coronary micro vascular dysfunction even in the absence of obstructive coronary artery disease (Gulati et al., 2021; Taqueti and Di Carli, 2016; Taqueti et al., 2017)
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From page 82... ...
(g) Cardiac PET can identify reduced myocardial blood flow and coronary flow reserve, which can indicate myocardial ischemia or coronary microvascular dysfunction.
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From page 83... ...
CMR provides superior spatial resolution for the comprehensive assessment of cardiovascular structure and function, including LGE evaluation for the assessment of myocardial viability and diagno sis of cardiomyopathies. CMR is the imaging method of choice for cardiomyopathies, for shunts, and for use in patients with congenital heart disease (DiGeorge et al., 2020)
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From page 84... ...
(h) The requirements for administering cardiac MRI in terms of equip ment and specialized expertise are similar to those described under imaging techniques in Chapter 3.
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From page 85... ...
is a noninvasive imaging technique that produces 3D images of the arteries to detect abnormalities in how blood flows through the heart. CCTA is used in the assessment of coronary artery disease (CAD)
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From page 86... ...
and coronary optical coherence tomography (OCT) are two types of invasive intravascular imaging tests used in interventional cardiology, which uses specialized catheter-based techniques for the comprehensive assessment of coronary artery disease.
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From page 87... ...
(c) The specific impairments more accurately assessed by intravascular imaging are acute and chronic coronary artery conditions, includ ing plaque rupture, spontaneous coronary artery dissection, and diffuse disease that appears "normal" in an angiography.
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From page 88... ...
assessment of the coronary circulation has re-emerged as an important adjunct to anatomic coronary imaging. Fractional flow reserve (FFR)
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From page 89... ...
(c) Coronary angiography is often insufficient in guiding percutaneous coronary intervention, so FFR has been increasingly used to estimate whether a coronary lesion will lead to myocardial ischemia (Garcia et al., 2019)
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From page 90... ...
Other indications for it use include unexplained syncope, progres sive c ardiac conduction disease, dilated cardiomyopathy, m uscular dystrophies (Duchenne, Becker) , post-antiarrhythmic surgery, sarcoidosis, congenital heart disease, and conduction disorders after transcatheter aortic valve replacement (Negru and Alzahrani, 2022)
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From page 91... ...
. EMERGING DIAGNOSTIC TECHNIQUES The advance described above have substantially improved diagnostic accuracy for numerous cardiovascular conditions.
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From page 92... ...
In the far future, continued advances in multimodality imaging technology, genetics and molecular biology, and artificial intelligence may further improve the precision of diagnoses involving cardiovascular conditions. Ultimately, however, despite these technological advances the assessment of the functional status of an individual, including the possibility of disability, will not be dependent on any single test of the cardiovascular system but will require a holistic approach integrated across organ systems and the individual's environment.
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From page 93... ...
2018. Sex and racial disparities in fractional flow reserve-guided percutaneous coronary intervention utilization: A 5-year national experience.
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From page 94... ...
2019. Relationship between FFR, CFR and coronary microvascular resistance -- Practical implications for FFR-guided percutaneous coronary intervention.
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From page 95... ...
2020. When to use intravascular ultrasound or optical coherence tomography during percutaneous coronary intervention?
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From page 96... ...
2016. Clinical significance of noninvasive coronary flow reserve assessment in patients with ischemic heart disease.
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From page 97... ...
2017. Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease -- State-of-the-evidence and clinical recommendations.
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