Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry.

BACKGROUND: The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). METHODS: Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). RESULTS: The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. CONCLUSIONS: In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.

Modern aspects of immunopathogenesis of autoimmune myocarditis.

Myocarditis (MC) is an inflammation of the cardiac muscle. Viral infections appear to be the most frequent cause for induction of MC. According to the I. Roitt's classification, autoimmune (AI) MC is an organ-specific form of AI pathology. Thus, autoreactive antibodies (auto-Abs) against myocardial antigens and autoreactive T cells are major pathogenic mechanisms, and they are a common cause of cardiac muscle disorder progression. The autoantigens from myocardial tissue (like cardiomyosin and etc.) and/or the phenomena of virus mimicry stimulate auto-Ab production and their cross-reactivity with myocardial antigens. Some auto-Abs in patients with AI diseases demonstrate DNA-hydrolytic or proteolytic abilities against autoantigen. We found both DNA-abzymes and protabzymes in some MC patients. They showed catalytic activity not only against non-specific polypeptide, but also specific activity against cardiomyosine. Proteolytic activities of protabzymes differ depending on the clinical form and activity of MC. This suggests a role of protabzymes in the pathogenesis of AI-MC. According to some authors, auto-Abs (including auto-Abs with catalytic ability) in patients with AI diseases can be additional regulatory factors of apoptosis.