Coronary tree

Mauriello A, Sangiorgi G, Fratoni S, et al. Diffuse and active inflammation occurs in both vulnerable and stable plaques of the entire coronary tree. J Am Coll Cardiol 2005 45 1585-1593. 

The discovery that coronary artery occlusion by thrombosis is itself stuttering — developing gradually over hours — and associated with vasospasm in other parts of the coronary tree has made the use of isosorbide dinitrate (Isoket) by continuous i.v. infusion adjusted to the degree of pain, a logical, and effective, form of analgesia for unstable angina. 

The surface electrocardiography (ECG) in both acute and chronic phase of ischaemic heart disease (IHD) may give crucial information about the coronary artery involved and which is the area of myocardium that is at risk or already infarcted. This information jointly with the ECG-clinical correlation is very important for prognosis and risk stratification, as will be demonstrated in this book. Therefore, we will give in the following pages an overview of the anatomy of the heart, especially the heart walls and coronary tree, and emphasise the best techniques currently used for its study. 

The most recent imaging techniques are CMR (Figure 1.4) and CMDCT (Figure 1.1). The latter is used for non-invasive study of coronary tree. CMR, which may also be used for perfusion and func-... 

The coronary tree coronary angiography and coronary multidetector computed tomography... 

The myocardium and specific conduction system (SCS) are perfused by the right coronary artery (RCA), the left anterior descending coronary artery (LAD) and the circumflex coronary artery (LCX). Figure 1.1 shows the great correlation of coronary angiography and CMDCT in normal coronary tree and some pathologic cases. 

C) The typical angiographic image (a,b) and normal coronary tree (c,d). 

Lansky A, Elashoff MR, Ng V et al (2012) A gender-specific blood-based gene expression score for assessing obstructive coronary artery disease in nondiabetic patients results of the Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) trial. Am Heart J 164 320-326... 

The widespread application suffers from improving but stiU insufficient temporal resolution. Most researchers therefore agree that a reduction in heart rate to lengthen the rest phase of the coronary tree is needed, even using the latest editions of scanner technology. 

Fig. 16. 7a-d. Representative coronary angiogram with PGA. a, b 3D Global views at different projection angles. No disease is apparent in the left and right coronary arteries. Volmne renderings of the same dataset with coronary tree isolation (c) and... 

Tremendous advances in scanner technology introduced in the recent years made cardiac CT a clinical reality. Automated software has reduced image postprocessing time to a few minutes. Coronary tree extraction allows obtaining projections of the CT dataset that resemble the views familiar from catheterization angiography. But application of the method today is confined to a selected range of patients. This is due to the many restrictions that prevail. 

Additionally, even 64-slice scanners are lacking in accuracy compared with ICA if a lumen quantification more exact is required (Leber et al. 2005), and it remains unclear if CT techniques even with 128- or 256-slice scanners will be able to achieve the high temporal and spatial resolution of ICA, which is a precondition for competing with the accepted invasive morphological gold standard in clinical routine diagnostic of the coronary tree. 

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