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New Genetic Insights in SCAD: Implications for Cardiology Practice

genetic insights scad cardiology

07/21/2025

In the evolving field of cardiology, new insights into genetic and familial factors are reshaping our understanding of Spontaneous Coronary Artery Dissection (SCAD), which accounts for approximately 1% to 4% of all ACS cases, frequently emerging in patients without prior coronary artery disease and posing critical diagnostic and treatment challenges.

Familial SCAD risk factors highlight the necessity for cardiologists to evaluate family histories during patient assessments. Familial clustering in SCAD cases suggests a genetic component that can be critical to understanding potential risks for other family members. Research provides evidence for genetic susceptibility, highlighting the importance of comprehensive pedigrees to guide proactive surveillance of at-risk relatives.

Coronary angiography remains the gold standard for confirming SCAD, facilitating visualization of dissection flaps or intramural hematomas and distinguishing these from atherosclerotic narrowing. As noted in the earlier report, adjunctive imaging modalities such as intravascular ultrasound and optical coherence tomography can clarify equivocal angiographic findings, especially when separating SCAD from other acute coronary syndrome presentations with or without ST-segment elevation.
While myocardial fibrosis due to sustained endurance exercise has been observed, the direct link to heightened SCAD risk remains hypothetical. Research on scar tissue in athletes' hearts points to repetitive hemodynamic stress as a potential factor, suggesting the need for vigilant cardiovascular monitoring and consideration of advanced imaging protocols for athletes engaged in high-intensity training.Implementing comprehensive family histories, genetic counseling, and appropriate imaging techniques into routine practice can improve early detection and prevention of SCAD. Developing structured screening programs for at-risk individuals, including family members and endurance athletes, may lead to personalized management strategies based on genetic predispositions and imaging findings. 

Key Takeaways:

  • Familial predisposition plays a critical role in SCAD, necessitating thorough family history evaluations.
  • Coronary angiography remains the gold standard for SCAD diagnosis, supported by advanced imaging techniques.
  • Endurance athletes with myocardial fibrosis face increased SCAD risk; regular cardiac evaluations are essential.
  • Genetic insights are paving the way for more personalized SCAD prevention and management strategies.

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