Functional recovery and quality-of-life improvement 12 months after LVAD implantation: A single-center cohort.

Coronary atherosclerosis is the dominant substrate for ischemic heart disease worldwide; modern care depends on detecting plaque, distinguishing anatomical narrowing from lesion-level ischemia, and linking findings to prevention or revascularization. Rapid advances in invasive and noninvasive imaging now enable clinicians to visualize the coronary lumen and wall, phenotype plaque, and quantify myocardial perfusion/flow, reshaping diagnostic pathways and therapeutic decisions [,]. Large comparative trials clarified each modality's sweet spot. An anatomic strategy anchored in coronary computed tomography angiography (CCTA) expedites diagnosis and safely excludes obstructive disease in low- to intermediate-risk chest pain, while physiology-first strategies using stress imaging or invasive pressure indices (fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR)) align revascularization with ischemia [,]. Simultaneously, outcome-focused work (e.g., Scottish Computed Tomography of the Heart Trial (SCOT-HEART), a randomized trial evaluating the addition of CCTA to standard care in patients with suspected stable angina) showed that simply identifying and reporting plaque, often non-obstructive, triggers intensified prevention and lowered myocardial infarction (MI) []. In stable disease, International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) [] demonstrated that routine early revascularization does not reduce death or MI versus optimal medical therapy, strengthening a test strategy that (1) efficiently rules out obstructive coronary artery disease (CAD) when unlikely, (2) proves lesion-specific ischemia when percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) is considered, and (3) escalates prevention when plaque biology signals risk []. Within this framework, we compare invasive tools - invasive coronary angiography (ICA) for lumenography, FFR/iFR for lesion physiology, and intravascular ultrasound/optical coherence tomography (IVUS/OCT) for plaque/stent characterization - with noninvasive approaches spanning coronary artery calcium (CAC) scoring, CCTA (± computed tomography-derived fractional flow reserve (CT-FFR)), and functional imaging (stress echocardiogram, single-photon emission computed tomography (SPECT), positron emission tomography (PET) with myocardial blood flow (MBF)/coronary flow reserve (CFR), and stress cardiovascular magnetic resonance (CMR)) []. We synthesize diagnostic performance and practical trade-offs, then offer stepwise, pragmatic algorithms for common scenarios, including how to resolve anatomy-physiology discordance and when to escalate to invasive assessment. Finally, we highlight fast-moving areas - CT-FFR, quantitative PET flow, high-risk plaque on CCTA, and OCT markers of vulnerability/healing - and their likely impact on real-world pathways.