[Evolution of the catheterization laboratory: new instruments and imaging techniques]. / L'evoluzione del laboratorio di cateterismo: nuovi strumenti e tecniche di imaging.

ABSTRACT

The Editorial Board of the Italian Heart Journal Supplement has planned to publish a series of four consecutive papers focusing on new highlights from the cardiac catheterization laboratory, developments of new devices, coronary imaging and physiological measurement. The first paper on cineless digital angiography and new fluoroscopy systems presented in this issue of the Journal has been prepared by Danzi et al. (Brescia). The paper follows the publication of the Vergara's work (Rovereto-TN) on a similar topic presented last year in a Symposium of the Gruppo Italiano di Studi Emodinamici (GISE) at the XXXI ANMCO meeting. The recent development of cineless digital angiography and the increasing interest in new digital fluoroscopic low energy systems represent a significant change in the management of cardiac images and have significant implications in the organization of a new catheterization laboratory. The second paper will focus on the clinical applications of intravascular ultrasound imaging and will be prepared by Di Mario (Milan). Intravascular ultrasound imaging has significantly contributed to the understanding of vascular adaptation to coronary artery disease and mechanisms of percutaneous coronary interventions. This new diagnostic approach is particularly useful in assessing the early stages of disease, evaluating occult atherosclerosis and guiding the strategy of coronary interventions. Unfortunately, the application of intravascular ultrasound imaging in clinical practice remains limited. The third paper prepared by Verna (Varese) will discuss the new techniques for physiological evaluation of coronary artery disease now available in the catheterization laboratory. The use of pressure and Doppler flow-wire in the assessment of functional significance of individual coronary artery stenoses and in the evaluation of the vasodilatory capacity of coronary microcirculation may provide new insights for the clinical decision at the catheterization table. In addition, the application of myocardial contrast echocardiography with new sonicated agents for intracoronary use may represent a novel approach to the direct evaluation of regional myocardial perfusion and microvascular integrity. Intracoronary stenting has become a widely used and accepted technique in percutaneous coronary interventions. The fourth article of this series, prepared by Silva (Milan), will discuss the advantages and limitations of stenting in different clinical settings based on the results of large clinical trials. In spite of the growing number of procedures safely performed in many countries, long-term results of intracoronary stenting may be sometimes disappointing in selected patients. In-stent restenosis still represents a clinical problem limiting long-term outcome. In addition, the increasing use of new antiplatelet agents in combination with most stenting procedures rise some concern about overall cost of interventions. The objective of this editorial program is to give a view of the changing scenario of the catheterization laboratory with the new methods and devices presently available. There may be significant implications and controversial issues of interest also for all clinical cardiologists.