Comparative assessment of non-invasive imaging in detecting coronary artery disease

Abstract

Coronary artery disease (CAD) has an important impact on the morbidity and mortality in the West and health service<br />resources worldwide. It is therefore crucial to accurately diagnose CAD early, in an attempt to limit its burden on patients<br />and society, potentially by optimum risk stratification, accurate diagnosis and management. Invasive coronary angiography<br />(ICA) is the conventional gold standard imaging investigation for the coronary circulation and assessment of disease severity.<br />However, it is an invasive procedure and is associated with risks, although rare. In addition, it detects luminal stenosis but<br />not the functional importance of those anatomical lesions. Therefore, a wide variety of non-invasive imaging developed<br />to evaluate the presence and severity of CAD, including anatomical techniques e.g. coronary CT that assesses coronary<br />stenosis, and quantifies coronary calcium, hence the burden of atherosclerotic plaques and functional imaging e.g. stress<br />echocardiography, nuclear imaging by SPECT and PET and stress CMR. Selection of the most appropriate imaging,<br />therefore, is challenging and requires knowledge of patients’ pre-test probability and prevalence of disease, their advantages<br />and limitations, cost and availability. This review attempts to provide an overview of the current supporting evidence of the<br />role of non-invasive imaging in diagnosing CAD, in addition to its prognostic value, limitations and advantages.