Article Sidebar

Download
PDF

Main Article Content

Abstract

ABSTRACT
The search for ischemic heart disease is essential in diabetic patients because of the potential risk of silent myocardial ischemia. Coronary computed tomography angiography (CCTA), readily available, less expensive and less invasive, remains a safe means of detecting coronary lesions. We describe the clinical case of a 67-year-old patient with a 26 year-history of hypertension and a 10 year-history of type 2 diabetes presenting a very high cardiovascular risk (ASCVD risk score = 41.6%), admitted for atypical chest discomfort resistant to usual gastric dressings and traditional analgesics. The electrocardiogram performed was non-specific. A CCTA was performed by prospective acquisition with ECG synchronization in spontaneous contrast then after injection It have revealed a coronary calcium score estimated at 852 AU and a significant tri-vessel coronary stenosis. Pending coronary revascularization, the patient remains stable under medical treatment based on fixed triple antihypertensive therapy, a beta-blocker, a statin and a dual antiplatelet agent.
 
RESUME
La recherche d'une cardiopathie ischémique est essentielle chez les patients diabétiques en raison du risque potentiel d'ischémie myocardique silencieuse. L'angiographie coronaire par tomodensitométrie (ACT), facilement disponible, moins coûteuse et moins invasive, reste un moyen sûr de détecter les lésions coronaires. Nous décrivons le cas clinique d'un patient de 67 ans, hypertendu depuis 26 ans et diabétique de type 2 depuis 10 ans, présentant un risque cardiovasculaire très élevé (score de risque ASCVD = 41,6 %), admis pour une gêne thoracique atypique résistant aux pansements gastriques habituels et aux analgésiques traditionnels. L'électrocardiogramme réalisé était non spécifique. Une ACT a été réalisée par acquisition prospective avec synchronisation ECG en contraste spontané puis après injection Elle a révélé un score calcique coronaire estimé à 852 UA et une sténose coronaire tri-vaisseaux significative. Dans l'attente d'une revascularisation coronaire, le patient reste stable sous traitement médical basé sur une triple thérapie antihypertensive fixe, un bêta-bloquant, une statine et un double antiagrégant plaquettaire.

Keywords

coronary artery, CT angiography, heart ischemia, diabetes artère coronaire, angiographie par tomodensitométrie, ischémie cardiaque, diabète

Article Details

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite
Sall F, Meneas GC, Akatchi R1, N’Guessan I, Kpi Y, & Adoubi KA. (2025). Coronary Computed Tomography Angiography for The Diagnosis of Ischemic Heart Disease in a Diabetic Patient: A Case Report and Literature Review. HEALTH SCIENCES AND DISEASE, 26(1). https://doi.org/10.5281/hsd.v26i1.6362
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. 1. Dweck MR, Williams MC, Moss AJ, Newby DE, Fayad ZA. Computed Tomography and Cardiac Magnetic Resonance in Ischemic Heart Disease. J Am Coll Cardiol. 2016;68:2201-16.
  2. 2. Kennedy MW, Fabris E, Suryapranata H, Kedhi E. Is ischemia the only factor predicting cardiovascular outcomes in all diabetes mellitus patients? Cardiovasc Diabetol. 2017;16:51.
  3. 3. Karagiannidis E, Moysidis DV, Papazoglou AS, Panteris E, Deda O, Stalikas N, Sofidis G, Kartas A, Bekiaridou A, Giannakoulas G, Gika H, Theodoridis G, Sianos G. Prognostic significance of metabolomic biomarkers in patients with diabetes mellitus and coronary artery disease. Cardiovasc Diabetol. 2022;21:70.
  4. 4. Einarson TR, Acs A, Ludwig C, et al. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientifc evidence from across the world in 2007–2017. Cardiovasc Diabetol 2018;17: 83.
  5. 5. Aronson D, Edelman ER. Coronary artery disease and diabetes mellitus. Cardiol Clin 2014; 32:439–55.
  6. 6. Naito R, Miyauchi K. Coronary artery disease and type 2 diabetes mellitus. Int Heart J. 2017;58:475–80 .
  7. 7. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 2002; 287: 2570–2581.
  8. 8. Esper RB, Farkouh ME, Ribeiro EE, et al. SYNTAX score in patients with diabetes undergoing coronary revascularization in the FREEDOM trial. J Am Coll Cardiol. 2018;72:2826–37.
  9. 9. Kharbouch, Hanane, et al. "Dépistage de l’ischémie myocardique silencieuse chez le diabétique." Journal Marocain des Sciences Médicales.2021 ;23.
  10. 10. Shah NR, Pierce JD, Kikano EG, Rahnemai-Azar AA, Gilkeson RC, Gupta A. CT Coronary Angiography Fractional Flow Reserve: New Advances in the Diagnosis and Treatment of Coronary Artery Disease. Curr Probl Diagn Radiol. 2021;50:925-36.
  11. 11. Pakkal M, Raj V, Mccann GP. Non-invasive imaging in coronary artery disease including anatomical and functional evaluation of ischaemia and viability assessment. Br J Radiol 2011;84(spec iss 3):S280–95
  12. 12. Saraste A, Knuuti J, Bax J. Screening for Coronary Artery Disease in Patients with Diabetes. Curr Cardiol Rep. 2023;251865-71.
  13. 13. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.
  14. 14. Sattar N, McMurray J, Borén J, Rawshani A, Omerovic E, Berg N, et al. Twenty years of cardiovascular complications and risk factors in patients with type 2 diabetes: a nationwide Swedish cohort study. Circulation. 2023;147:1872–86.
  15. 15. Roth GA, Huffman MD, Moran AE, Feigin V, Mensah GA, Naghavi M, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;132:1667–78.
  16. 16. Ramsey BC, Fentanes E, Choi AD, Branch KR, Thomas DM. Myocardial Assessment with Cardiac CT: Ischemic Heart Disease and Beyond. Curr Cardiovasc Imaging Rep. 2018;11:16.
  17. 17. Hammoud T, Tanguay JF, Bourassa MG. Management of coronary artery disease: therapeutic options in patients with diabetes. J Am Coll Cardiol 2000;36:355-65.
  18. 18. Sirajuddin A, Mirmomen SM, Kligerman SJ, Groves DW, Burke AP, Kureshi F, White CS, Arai AE. Ischemic Heart Disease: Noninvasive Imaging Techniques and Findings. Radiographics. 2021;41:990-1021.
  19. 19. Jensen RV, Hjortbak MV, Bøtker HE. Ischemic Heart Disease: An Update. Semin Nucl Med. 2020;50:195-207
  20. 20. Teo KK, Rafiq T. Cardiovascular Risk Factors and Prevention: A Perspective From Developing Countries. Can J Cardiol. 2021;37:733-43.
  21. 21. R. Hajar.Framingham contribution to cardiovascular disease
  22. Heart Views, 2016;17,78-81.
  23. 22. Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014;383:999-1008.
  24. 23. Li X, Wu C, Lu J, Chen B, Li Y, Yang Y, Hu S, Li J. Cardiovascular risk factors in China: a nationwide population-based cohort study. Lancet Public Health. 2020 ;5:e672-e681. -2. Erratum in: Lancet Public Health. 2021;6:e271
  25. 24. Fletcher B, Gulanick M, Lamendola C. Risk factors for type 2 diabetes mellitus. J Cardiovasc Nurs. 2002;16:17-23.
  26. 25. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-52.
  27. 26. O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, Rao-Melacini P, Zhang X, Pais P, Agapay S, Lopez-Jaramillo P, Damasceno A, Langhorne P, McQueen MJ, Rosengren A, Dehghan M, Hankey GJ, Dans AL, Elsayed A, Avezum A, Mondo C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Wang X, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Magazi D, Nilanont Y, Ferguson J, Pare G, Yusuf S; INTERSTROKE investigators. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388:761-75.
  28. 27. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388:1459-544.
  29. 28. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001;104:2855-64.
  30. 29. Yun JS, Ko SH. Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes.Metabolism. 2021 ;123:154838.
  31. 30. Lechner K, von Schacky C, McKenzie AL, Worm N, Nixdorff U, Lechner B, Kränkel N, Halle M, Krauss RM, Scherr J. Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors. Eur J Prev Cardiol. 2020 ;27:394-406.
  32. 31. WHO. WHO/Fact sheets/Detail/Cardiovascular diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) (2017, 14 March 2019).
  33. 32. Boyle J, Honeycutt A, Narayan K, Hoerger T, Geiss L, Chen H, Thompson T. Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care. 2001;24:1936–40.
  34. 33. J.-L. Schlienger, L. Monnier, N. Essekat, A. ElAzrak, F. Raji, D. Rochd. Risk factors and chronic iseases: Diabetes as an example. Médecine des maladies Métaboliques. 2019;13.
  35. 34. S.R. Preis, S.J. Hwang, S. Coady, M.J. Pencina, R.B. D’Agostino Sr., P.J. Savage, et al.Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005.Circulation. 2009;119 :1728-35.
  36. 35. E.W. Gregg, Y.J. Cheng, S. Saydah, C. Cowie, S. Garfield, L. Geiss, et al.Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey.Diabetes Care. 2012;35:1252-1257
  37. 36. Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, Young JB, Nissen SE. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001;103:2705–10.
  38. 37. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868–74
  39. 38. Hansson, Göran K. "Inflammation, atherosclerosis, and coronary artery disease." New England journal of medicine. 2005;352:1685-95.
  40. 39. Kovanen, PT, Kaartinen, M, Paavonen, T. Infiltrates of activated mast cells at the site of coronary atheromatous erosion or rupture in myocardial infarction. Circulation 1995;92:1084-88
  41. 40. Hansson, GK, Holm, J, Jonasson, L. Detection of activated T lymphocytes in the human atherosclerotic plaque. Am J Pathol 1989;135:169-75
  42. 41. Van der Wal, AC, Becker, AE, van der Loos, CM, Das, PK. Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation 1994;89:36-44
  43. 42. Frostegard, J, Ulfgren, AK, Nyberg, P, et al. Cytokine expression in advanced human atherosclerotic plaques: dominance of pro-inflammatory (Th1) and macrophage-stimulating cytokines. Atherosclerosis 1999;145:33-43
  44. 43. Moreno, PR, Falk, E, Palacios, IF, Newell, JB, Fuster, V, Fallon, JT. Macrophage infiltration in acute coronary syndromes: implications for plaque rupture. Circulation 1994;90:775-78.
  45. 44. Jones, CB, Sane, DC, Herrington, DM. Matrix metalloproteinases: a review of their structure and role in acute coronary syndrome. Cardiovasc Res 2003;59:812-23
  46. 45. Liu, J, Sukhova, GK, Sun, JS, Xu, WH, Libby, P, Shi, GP. Lysosomal cysteine proteases in atherosclerosis. Arterioscler Thromb Vasc Biol 2004;24:1359-66.
  47. 46. Hansson, GK, Hellstrand, M, Rymo, L, Rubbia, L, Gabbiani, G. Interferon-gamma inhibits both proliferation and expression of differentiation-specific alpha-smooth muscle actin in arterial smooth muscle cells. J Exp Med 1989;170:1595-608.
  48. 47. Amento, EP, Ehsani, N, Palmer, H, Libby, P. Cytokines and growth factors positively and negatively regulate interstitial collagen gene expression in human vascular smooth muscle cells. Arterioscler Thromb 1991;11:1223-30.
  49. 48. Saren, P, Welgus, HG, Kovanen, PT. TNF-alpha and IL-1beta selectively induce expression of 92-kDa gelatinase by human macrophages. J Immunol 1996;157:4159-65.
  50. 49. Mach, F, Schonbeck, U, Bonnefoy, JY, Pober, JS, Libby, P. Activation of monocyte/macrophage functions related to acute atheroma complication by ligation of CD40: induction of collagenase, stromelysin, and tissue factor. Circulation 1997;96:396-99
  51. 50. Momiyama, Yukihiko, et al. "Inflammation, atherosclerosis and coronary artery disease." Clinical Medicine Insights: Cardiology .2014; 8: CMC-S39423.
  52. 51. Libby, Peter, and Pierre Theroux. "Pathophysiology of coronary artery disease." Circulation .2005;111: 3481-88.
  53. 52. Onat, A., Dönmez, İ., Karadeniz, Y., Çakır, H., & Kaya, A.). Type-2 diabetes and coronary heart disease: common physiopathology, viewed from autoimmunity. Expert Review of Cardiovascular Therapy. 2014;12:667–79.
  54. 53. Yahagi K, Kolodgie FD, Lutter C, Mori H, Romero ME, Finn AV, Virmani R. Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus. Arterioscler Thromb Vasc Biol. 2017;37:191-204.
  55. 54. Gitsioudis G., Schüssler A., Nagy E. Combined Assessment of high-sensitivity troponin T and noninvasive coronary plaque composition for the prediction of cardiac outcomes. Radiology. 2015;276:73–81.
  56. 55. Barone-Rochette, G. "Comment positionner le score calcique dans le dépistage de la coronaropathie?." Archives des Maladies du Coeur et des Vaisseaux-Pratique 2023.319 (2023): 2-7.
  57. 56. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008;52:1724–32.
  58. 57. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, et al. Coronary Artery Disease-Reporting and Data System (CAD-RADS): An expert consensus document of SCCT, ACR and NASCI: Endorsed by the ACC. JACC Cardiovasc Imaging 2016;9. 1099-13.
  59. 58. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300:1350–8.
  60. 59. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41:407-77.
  61. 60. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827-32 .
  62. 61. McClelland RL, Jorgensen NW, Budoff M, Blaha MJ, Post WS, Kronmal RA, Bild DE, Shea S, Liu K, Watson KE, Folsom AR, Khera A, Ayers C, Mahabadi AA, Lehmann N, Jöckel KH, Moebus S, Carr JJ, Erbel R, Burke GL. 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). J Am Coll Cardiol. 2015;66:1643-53.
  63. 62. Blaha MJ, Cainzos-Achirica M, Greenland P, McEvoy JW, Blankstein R, Budoff MJ, Dardari Z, Sibley CT, Burke GL, Kronmal RA, Szklo M, Blumenthal RS, Nasir K. Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2016;133:849-58.
  64. 63. Cohn PF, Fox KM, Daly C. Silent myocardial ischemia. Circulation. 2003;108:1263-77.
  65. 64. Theofilis P, Antonopoulos AS, Sagris M, Papanikolaou A, Oikonomou E, Tsioufis K, Tousoulis D. Silent Myocardial Ischemia: From Pathophysiology to Diagnosis and Treatment. Biomedicines. 2024;12:259.
  66. 65. Berry C, Kramer CM, Kunadian V, Patel TR, Villines T, Kwong RY, Raharjo DE. Great Debate: Computed tomography coronary angiography should be the initial diagnostic test in suspected angina. Eur Heart J. 2023;44:2366-75.
  67. 66. Gray AJ, Roobottom C, Smith JE, Goodacre S, Oatey K, O'Brien R, Storey RF, Curzen N, Keating L, Kardos A, Felmeden D, Lee RJ, Thokala P, Lewis SC, Newby DE; RAPID-CTCA Investigators. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. BMJ. 2021 Sep 29;374:n2106. doi: 10.1136/bmj.n2106. Erratum in: BMJ. 2022;376:o438.
  68. 67. Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S; ESC Scientific Document Group. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45:3415-3537.
  69. 68. Serruys PW, Hara H, Garg S, Kawashima H, Nørgaard BL, Dweck MR, Bax JJ, Knuuti J, Nieman K, Leipsic JA, Mushtaq S, Andreini D, Onuma Y. Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78:713-736.
  70. 69. Serruys PW, Kotoku N, Nørgaard BL, Garg S, Nieman K, Dweck MR, Bax JJ, Knuuti J, Narula J, Perera D, Taylor CA, Leipsic JA, Nicol ED, Piazza N, Schultz CJ, Kitagawa K, Bruyne B, Collet C, Tanaka K, Mushtaq S, Belmonte M, Dudek D, Zlahoda-Huzior A, Tu S, Wijns W, Sharif F, Budoff MJ, Mey J, Andreini D, Onuma Y. Computed tomographic angiography in coronary artery disease. EuroIntervention. 2023;18:e1307-e1327.
  71. 70. Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, Cole J, Dolor RJ, Fordyce CB, Huang M, Khan MA, Kosinski AS, Krucoff MW, Malhotra V, Picard MH, Udelson JE, Velazquez EJ, Yow E, Cooper LS, Lee KL; PROMISE Investigators. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015;372:1291-300.
  72. 71. SCOT-HEART Investigators; Newby DE, Adamson PD, Berry C, Boon NA, Dweck MR, Flather M, Forbes J, Hunter A, Lewis S, MacLean S, Mills NL, Norrie J, Roditi G, Shah ASV, Timmis AD, van Beek EJR, Williams MC. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018;379:924-933.
  73. 72. Mézquita AJV, Biavati F, Falk V, Alkadhi H, Hajhosseiny R, Maurovich-Horvat P, Manka R, Kozerke S, Stuber M, Derlin T, Channon KM, Išgum I, Coenen A, Foellmer B, Dey D, Volleberg RHJA, Meinel FG, Dweck MR, Piek JJ, van de Hoef T, Landmesser U, Guagliumi G, Giannopoulos AA, Botnar RM, Khamis R, Williams MC, Newby DE, Dewey M. Clinical quantitative coronary artery stenosis and coronary atherosclerosis imaging: a Consensus Statement from the Quantitative Cardiovascular Imaging Study Group. Nat Rev Cardiol. 2023;20:696-714.
  74. 73. Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM, Prescott E, Karam N, Appelman Y, Fraccaro C, Louise Buchanan G, Manzo-Silberman S, Al-Lamee R, Regar E, Lansky A, Abbott JD, Badimon L, Duncker DJ, Mehran R, Capodanno D, Baumbach A. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J. 2020;41:3504-20.
  75. 74. Ong P, Athanasiadis A, Borgulya G, Vokshi I, Bastiaenen R, Kubik S, Hill S, Schäufele T, Mahrholdt H, Kaski JC, Sechtem U. Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries. Circulation. 2014;129:1723-30.
  76. 75. Taqueti VR, Hachamovitch R, Murthy VL, Naya M, Foster CR, Hainer J, Dorbala S, Blankstein R, Di Carli MF. Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization. Circulation. 2015;131:19-27
  77. 76. Ong P, Seitz A. Advances in Risk Stratification of Patients With Coronary Microvascular Dysfunction: Usefulness of Stress Perfusion CMR. JACC Cardiovasc Imaging. 2021;14:612-614.

Most read articles by the same author(s)

Similar Articles

<< < 1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.