Noninvasive Coronary Artery Imaging Research Articles

Prognostic Significance of Targeted Magnetic Resonance Coronary Angiography to Predict Cardiac Events in Patients with Known or Suspected Coronary Artery Disease

Background: Magnetic resonance coronary angiography (MRCA) is one of the most promising tools for noninvasive imaging of coronary arteries without radiation exposure or contrast media administration. However, knowledge about the prognostic value of MRCA is limited. Materials and Methods: The present study included 389 patients with known or suspected coronary artery disease (CAD) underwent clinical cardiac magnetic resonance (CMR) including MRCA imaging. The presence of a significant coronary artery stenosis was defined by visual estimation of ≥50% diameter reduction using targeted MRCA images. Patients were followed up for hard cardiac events (cardiac death or non-fatal myocardial infarction) and major adverse cardiac events (MACE) which also included hospitalization for heart failure and late revascularization (>180 days after the CMR study). Results: The average age was 68±11 years and 48% were male. One hundred and thirty-nine patients had significant stenosis on MRCA. During a median follow-up period of 53.9 months, 23 hard cardiac events and 52 MACE, occurred. Patients with significant coronary artery stenosis had higher rates of hard cardiac events (annual event rate 3.12% versus 0.56%, HR 5.52, 95% CI 2.17 to 14.01, p<0.001) and MACE (annual event rate 6.44% versus 1.83%, HR 3.49, 95% CI 1.98 to 6.14, p<0.001) than those without significant stenosis. Multivariable analyses identified significant coronary artery stenosis as an independent predictor of hard cardiac events (HR 3.35, 95% CI 1.13 to 9.96, p=0.03) and MACE (HR 2.00, 95% CI 1.02 to 3.90, p=0.04). MRCA presented an incremental prognostic value over clinical factors, left ventricular ejection fraction, and myocardial scarring to predict hard cardiac events (p=0.03). Conclusion: Targeted MRCA demonstrated independent and incremental prognostic values to predict future cardiac events in patients with known or suspected CAD. Keywords: Cardiac magnetic resonance imaging; Coronary artery disease; Magnetic resonance coronary angiography; Prognosis

An echocardiographic clue for ostial left main coronary artery stenosis

Calcified nodules in human coronary arteries are usually focally distributed. Non-invasive imaging of coronary arteries by bedside emergency transthoracic echocardiography in adults is possible and may become a useful adjunct to other methods of coronary artery examination. Coronary artery stenosis can be identified as localized color aliasing and accelerated flow velocities. Complete visualization of individual ostial coronary segments might ease the demonstration of coronary stenosis by bedside transthoracic echocardiography. The left main coronary artery stenosis requires prompt emergency evaluation and treatment because emergency conditions have higher mortality rates. The authors wish to emphasize the usefulness of emergency bedside echo-Doppler for a prompt diagnosis and treatment of this life-threatening condition.

MODELS OF MAJOR ADVERSE CARDIAC EVENT RISK USING RESULTS OF EXERCISE STRESS ECHOCARDIOGRAPHY WITH NONINVASIVE CORONARY ARTERY FLOW ASSESSMENT IN PATIENTS WITH ISCHEMIC HEART DISEASE

Ultrasound non-invasive coronary artery imaging contributes to the diagnosis of ischemic heart disease (IHD) in clinical practice. However, data of the prognostic value obtained from a complex analysis of contractility disorders and coronary blood flow parameters during exercise tests in the world literature are still not available. Aim. To develop risk models for adverse outcomes in patients with probable or definite IHD based on the results of a stress test with a noninvasive coronary blood flow study. Material and methods. Medical data of 689 patients with probable or definite IHD who underwent stress echocardiography with satisfactory visualization of the anterior interventricular artery (AIVA) were included in the analysis. All patients had stress echocardiography on a horizontal bicycle ergometer. Registration of coronary blood flow in the middle third of the AIVA was performed at rest and at the peak of the load with calculation of the coronary reserve value. Further patient follow-up lasted 3 years. Models of further negative outcomes were developed on the basis of the stress echocardiography results and of coronary blood flow parameters. Results. Three models that take into account the factors associated with further mortality, mortality/myocardial infarction and sum of negative outcomes were developed in the study. These models divide a cohort of patients with probable or definite IHD into groups of low, medium and very high risks. Factors associated with the risk of death include: age >56 years, load power <100 W, breach of contractility in the blood supply zone of the circumflex artery initially and during exercise, the difference in blood flow velocities in the AIVA<10 cm/s, coronary reserve of AIVA<2. The risk model of death, taking into account these factors, suggests dividing patients into low-risk group if there are ≤2 factors (mortality 0.6% for 3 years), medium risk – from 2 to 4 factors (mortality 1.8%), high risk – ≥5 factors (mortality 10.3% for 3 years). Conclusion. The study of coronary blood flow during stress echocardiography in addition to the analysis of left ventricular contractility in patients with probable or definite IHD contributes to determine the prognosis of further negative outcomes.

Intravascular NIRF Molecular Imaging Approaches in Coronary Artery Disease.

Progression of vulnerable coronary atherosclerotic plaques underlies the majority of acute myocardial infarction and sudden cardiac death episodes. Recent advances in biological/molecular imaging technology are now enabling the accurate identification of high-risk plaques and stents in living subjects. Due to their smaller caliber and susceptibility to cardiorespiratory motion, noninvasive molecular imaging of human coronary arteries remains challenging. Therefore, intravascular high-resolution molecular imaging approaches appear necessary to resolve molecular features of human coronary arteries and stents. Here we present recent progress in intravascular near-infrared fluorescence (NIRF) molecular imaging, including the evolution from standalone NIRF systems to those integrated with structural imaging methods including optical coherence tomography and intravascular ultrasound. Preclinical demonstrations of imaging inflammation, fibrin, and endothelial impairment are highlighted. We then close with a discussion of translation of NIRF imaging to the cardiac catheterization laboratory and showcase first-in-human intracoronary imaging results of NIR autofluorescence in CAD.

Why currently used diagnostic techniques for heart failure in rheumatoid arthritis are not enough: the challenge of cardiovascular magnetic resonance imaging.

Rheumatoid arthritis (RA) is a multiorgan inflammatory disorder affecting approximately 1% of the population that leads to progressive joint destruction and disability. Patients with RA exhibit a high risk of cardiovascular disease, which results in premature morbidity and mortality and reduced life expectancy, when compared with the general population. Among various guises of myocardial involvement, heart failure (HF) has been recently recognized as an important contributory factor to the excess cardiovascular mortality associated with RA. HF in RA typically presents with occult clinical symptomatology and is mainly associated with structural and functional left ventricular abnormalities leading to diastolic dysfunction, while systolic myocardial performance remains well preserved. As isolated diastolic dysfunction is a predictor of high mortality, the evaluation of patients in early asymptomatic stages, when treatment targeting the heart is more likely to be effective, is of great importance. Although patient history and physical examination remain the cornerstones of HF evaluation, noninvasive imaging of cardiac chambers, coronary arteries, and great vessels may be necessary. Echocardiography, nuclear techniques, and invasive coronary angiography are already established in the routine assessment of HF; however, many aspects of HF pathophysiology in RA remain obscure, due to the limitations of currently used techniques. The capability of cardiovascular magnetic resonance (CMR) to capture early tissue changes allows timely detection of pathophysiologic phenomena of HF in RA, such as myocardial inflammation and myocardial perfusion defects, due to either macrovascular (coronary artery disease) or microvascular (vasculitis) disease. Therefore, CMR may be a useful tool for early, accurate diagnosis and research in patients with RA.

Percutaneous Closure of Atrial Septal Defects in Patients with an Aberrant Retroaortic Coronary Artery: Is It Safe?

Coexistence of an ostium secundum type atrial septal defect and a coronary artery anomaly with an aberrant retroaortic course is a rare congenital anomaly that may potentially complicate percutaneous atrial septal defects (ASD) closure. If the anterosuperior rim of the defect is deficient, the abnormally located coronary artery may be compressed or distorted by the implanted device causing myocardial ischemia, arrhythmias, and eventually sudden cardiac death. Due to the potential occurrence of these fatal cardiac events, diagnosis of an aberrant coronary artery with a retroaortic course must be established before percutaneous ASD closure. In this report, two patients with this rare association are described in whom percutaneous closure of the defect was feasible and uneventful. The importance of a careful periprocedural, noninvasive echocardiographic coronary artery imaging is emphasized, and the rational for percutaneous atrial septal defect closure in this unusual anatomic arrangement is proposed.

Does cholesterol drive atherosclerosis?

O of the most enduring views held by mainstream medicine is the close association between circulating cholesterol and cardiovascular disease and in particular coronary heart disease. Except under rare circumstances, a prerequisite precursor to acute coronary or cardiovascular events of an ischemic nature is atherosclerosis, which is known to start in some individuals at an early age and the prevalence is strongly age dependent. It is widely believed that cholesterol drives atherosclerosis, a notion that can be found in the introductions of hundreds of papers. The advent of non-invasive coronary artery imaging techniques such as electron beam computed tomography and coronary computed tomographic angiography have allowed medical scientists to inadvertently test this hypothesis by direct observation of the prevalence and progression of calcified, mixed and non-calcified coronary plaque. The results of a large number of studies involving a broad spectrum of age, ethnic background and both genders fail to support this hypothesis and in fact find a total lack of correlation between circulating total or LDL cholesterol and coronary plaque burden and progression in individuals with subclinical atherosclerosis, including type 2 diabetics who have well documented elevated risk of acute cardiovascular events. Furthermore, a number of studies have consistently found that lipid lowering, especially with the statin class of drug, fails to impact either the prevalence or progression of subclinical coronary atherosclerosis in either non-diabetics or diabetics. This apparent falsification of the hypothesis that cholesterol drives coronary atherosclerosis continues to be ignored. Furthermore, in true primary prevention trials using statin therapy to prevent acute coronary events in both non-diabetic and diabetic individuals, almost all generate absolute risk reductions that are very small, some would say not clinically significant, and there is no impact on mortality. The belief that this approach represents significant preventive therapy, especially for those who are asymptomatic but judged of high risk, including diabetics, is based on relative risk reductions which have the well recognized and intrinsic potential for exaggerating benefit and misleading clinical practice. Large numbers needed to treat to prevent one acute event suggests the need for a new paradigm.

Stress Testing and Non-Invasive Coronary Angiography in Patients with Suspected Coronary Artery Disease: Time for a New Paradigm

Diagnosis and management of coronary artery disease represents major challenges to our health care system, affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease was possible only through cardiac catheterization and invasive coronary angiography. To avoid the risks of an invasive procedure, stress testing is often employed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for cardiac catheterization. With the emergence of non-invasive coronary angiography, the question arises if such a strategy is still sensible, particularly, in view of only a modest agreement between stress testing results and the presence of coronary artery disease established by cardiac catheterization. Much data in support of the diagnostic accuracy and prognostic value of non-invasive coronary angiography by computed tomography have emerged within the last few years. These data challenge the role of stress testing as the initial imaging modality in patients with suspected coronary artery disease. This article reviews the clinical utility, limitations, as well as the hazards of stress testing compared with non-invasive coronary artery imaging by computed tomography. Finally, the implications of this review are discussed in relation to clinical practice.

Noninvasive Coronary Artery Imaging: Current Clinical Applications

1. Multidetector computed tomography (MDCT) is currently the preferred noninvasive modality that can reliably image coronary arteries. 2. Magnetic resonance imaging (MRI) of the coronaries has limited indications of assessing suspected coronary anomalies and complex congenital heart disease performed at expert centres. 3. The strength of MDCT is to rule out significant coronary artery disease (CAD) in a low-intermediate risk population with symptoms. This has been demonstrated in multi-centre trials. 4. Other appropriate indications for coronary CTA include: a. Investigation of equivocal or uninterpretable stress tests. b. Evaluation of suspected coronary anomalies/complex congenital heart disease. c. Evaluation of new onset heart failure/cardiomyopathy of unknown aetiology. d. Mapping of coronary vasculature including internal mammary artery before repeat CABG. e. Evaluation of left bundle branch block. f. Excluding significant CAD in select population before valve surgery. 5. It is not appropriate to perform coronary CTA on patients who are asymptomatic or have known significant CAD or high pre-test probability of CAD. 6. Use of MDCT to evaluate acute chest pain in emergency department has been studied by a number of single centre trials. Whilst the results are encouraging, we await multi-centre randomised trials and cost-effectiveness studies before recommending routine use locally. 7. The evaluation of stents and CABG patency has limited application in select scenarios. 8. Reporting of stenosis severity should be in defined categories rather than specific numbers and comment made on the type of plaque involved. 9. Radiation exposure should be kept to a minimum in line with the ALARA principle. All dose saving measures should be routinely employed where appropriate. 10. Expertise in performance and interpretation of such scans is very important.

Meta-analysis: Diagnostic Performance of Low-Radiation-Dose Coronary Computed Tomography Angiography

A new radiation dose-saving technique for noninvasive coronary artery imaging with computed tomography (CT) is available. To summarize current evidence about the ability of low-dose coronary CT angiography to rule out coronary artery disease (CAD) in symptomatic adults. Online databases, including MEDLINE, EMBASE, and the Cochrane Library, from inception through 31 October 2010; abstract databases; gray literature; reference lists of identified articles; and experts. No language restrictions were applied. All investigators screened and selected studies that compared prospective electrocardiography-gated coronary CT angiography with catheter coronary angiography (the reference standard) in symptomatic patients with suspected CAD. Two investigators independently extracted patient and study protocol characteristics and rated methodological quality; differences were resolved by consensus or by a third reader. Multivariate random-effects models were used to obtain pooled estimates. 16 studies, comprising 960 patients, were found (7 studies of single-source, 64-slice CT; 4 of dual-source, 64-slice CT; 2 of single-source, 320-slice CT; 1 dual-source, 128-slice CT; 1 of single-source, 128-slice CT; and 1 of single-source, 256-slice CT). On average, 2.4% of the coronary arterial segments were of nondiagnostic image quality, and 1 or more segments were nondiagnostic in 9.5% of the patients. The patient-level sensitivity and specificity of CT angiography were 1.00 (95% CI, 0.98 to 1.00) and 0.89 (CI, 0.85 to 0.92), respectively. The pooled vessel- and segment-level estimates showed lower sensitivity and higher specificity than the patient-level estimates. Statistically significant heterogeneity was found between studies for vessel- and segment-level estimates, which seemed to be associated with body mass index and prevalence of CAD but not with CT scanner characteristics. The small number of studies, half of which were from a single tertiary center, limits generalizability. The potential harms of the imaging tests were not well-evaluated. Early evidence suggests that low-dose coronary CT angiography matches the sensitivity of catheter-based angiography, has low radiation exposure, and is a potentially valid alternative to catheter angiography for triaging symptomatic patients with a clinical suspicion of CAD. None.

Noninvasive Evaluation of Coronary Reperfusion by CT Angiography in Patients With STEMI

The aim of this study was to determine whether 64-slice multidetector computed tomography (MDCT) can differentiate coronary reperfusion with Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 from TIMI flow grade ≤ 2 after ST-segment elevation myocardial infarction (STEMI). Multidetector computed tomography has become a popular modality for noninvasive coronary artery imaging. Recently, 64-slice MDCT has been applied to evaluate coronary arteries in acute coronary artery disease. The presence or absence of distal reperfusion in infarct-related arteries (IRA) was visualized with 64-slice MDCT during the acute phase in 87 non-high-risk patients after STEMI. To differentiate TIMI flow grade 3 from TIMI flow grade 2, we calculated the computed tomography (CT) number ratio by dividing the CT number of the contrast-enhanced coronary lumen at the most distal IRA by that at the proximal site to the culprit lesion in patients with reperfusion on MDCT. The MDCT findings were compared with TIMI flow grade with invasive coronary angiography (ICA) performed 20 ± 5 min later. According to ICA, 58 patients had TIMI flow grade 0 or 1, 17 had TIMI flow grade 2, and 12 had TIMI flow grade 3, whereas distal reperfusion was evident on MDCT in 28 of the 29 patients with TIMI flow grade ≥ 2 and absent in 55 of the 58 with TIMI flow grade ≤ 1. The CT number ratio was significantly higher in TIMI flow grade 3 than in TIMI flow grade ≤ 2 (0.64 ± 0.11 vs. 0.37 ± 0.12; p < 0.0001). The sensitivity, specificity, and accuracy of a diagnosis of TIMI flow grade 3 on the basis of a CT number ratio of ≥ 0.54 that was an optimal cutoff value determined by receiver-operator characteristic curve analysis were 92%, 97%, and 97%, respectively. Visualization of the IRA by 64-slice MDCT enables noninvasive differentiation of angiographic TIMI flow grade 3 from TIMI flow grade ≤ 2 coronary reperfusion during the acute phase in patients with STEMI.

Ionizing radiation risks of cardiac imaging: estimates of the immeasurable

For many decades, the search for a non-invasive visualization of the coronary arteries seemed to remain an unfulfilled promise to clinical cardiologists. Owing to the rapid refinements successfully implemented in computed tomography (CT) technology over the past few years, non-invasive imaging of coronary arteries is now not only feasible but also has become a reality in daily routine. This may—at least in part—have contributed to the fact that the number of CT scans performed in the USA has quadrupled since 1993.1 Although in a recent US survey CT and nuclear imaging accounted for just 21% of the total number of procedures, they resulted in >75% of the total cumulative effective radiation dose. We have witnessed an impressive six-fold increase in the radiation dose from medical imaging delivered per patient over the last 3 decades.1–2 Interestingly, half …

The Diagnostic Accuracy of 64-Detector Cardiac Computed Tomography Compared With Stress Nuclear Imaging in Patients Undergoing Invasive Cardiac Catheterization

The aim of this study was to evaluate the diagnostic accuracy of nuclear stress imaging as compared with noninvasive coronary artery imaging using 64-detector row cardiac computed tomography. Compared with invasive coronary angiography, multidetector row cardiac computed tomographic angiography (CTA) has shown promise in the accurate detection of coronary stenosis. Myocardial perfusion imaging (MPI) using single photon emission computed tomography is an established method for noninvasively assessing the functional significance of coronary stenosis. This study compared the accuracy of CTA and that of MPI in the detection of relevant lesions of coronary arteries. One hundred twenty-two symptomatic patients (77% males) with cardiac catheterization who also underwent MPI and CTA evaluations within 6 months at 2 centers were included. Comparison of CTA for lesions causing greater than 50% and greater than 70% coronary narrowing versus respective lesions on invasive cardiac catheterization (IC) was performed. Similarly, comparison of MPI findings with greater than 50% and greater than 70% lesions on IC was done. The per-patient sensitivity, specificity, and positive and negative predictive values in detecting greater than 50% coronary lesions on IC for CTA were 98.9%, 74.2%, 91.8%, and 95.8%, respectively; and for MPI, 56%, 38.7%, 72.9%, and 23%, respectively. The sensitivity, the specificity, and the positive and negative predictive values in detecting greater than 70% coronary lesions on IC for CTA were 89.7%, 86.4%, 92.1%, and 82.6%, respectively; and for MPI, 57.7%, 43.2%, 64.3%, and 36.5%, respectively. The prevalence of significant coronary artery disease on cardiac catheterization was 74.6% for greater than 50% stenosis and 63.9% for greater than 70% stenosis. Compared with MPI, CTA provided important information and identified significant lesions in symptomatic intermediate- to high-risk patients. Cost-effective and prospective multicentered studies, currently underway, are needed to further establish the best use of these diagnostic tests in the evaluation of coronary artery disease.

Stress echocardiography in the age of multi-detector computed tomography

The introduction of 64-slice multi-detector computed tomography (CT) in 2005 made the non-invasive imaging of coronary arteries relatively easy to perform. Computed tomography coronary angiography (CTCA) has been shown to be highly accurate at detecting coronary artery disease (CAD), when compared with invasive X-ray coronary angiography and, in particular, has an excellent negative predictive value (NPV).1,2 There are also prognostic data confirming very low risk for patients with normal CTCA.3 One of the limitations of multidetector CT and despite very good temporal resolution of 150 ms, with half scan reconstruction, is the need for beta-Blockers to slow the heart rate to 65 bpm, for retrospective, and 60 bpm, for the low radiation dose, prospective gated acquisitions. This is to minimize coronary motion particularly of the right coronary artery. Dual-source CT, with twice the temporal resolution, can cope with faster heart rates, whereas the 320-slice CT can image the heart in one heart beat. The UK national institute of clinical excellence (NICE) have recently produced guidelines on the management of patients with chest pain of recent onset, endorsing the use of CTCA in their investigational algorithm. We discuss the radiation dose associated with …

ECG-gated multidetector-row computed tomography in the assessment of left ventricular function

An accurate quantitative and qualitative assessment of cardiac function is critical for clinical diagnosis, risk stratification, management and prognosis in patients with suspected or documented heart disease. Magnetic resonance, owing to its excellent temporal and spatial resolution, is currently considered a reference standard in the assessment of cardiac function. Multidetector-row computed tomographic scanners, with sub-second rotation times and dedicated cardiac reconstruction algorithms, have shown their ability to acquire high-resolution images suitable for coronary imaging. With retrospective ECG - gating technique, diastolic and systolic images can be produced and analyzed to assess left ventricle functional parameters. The combination of noninvasive coronary artery imaging and assessment of cardiac function with multidetector-row computed tomography is a suitable approach to a conclusive cardiac work-up in patients with suspected coronary artery disease.

Coronary artery noninvasive imaging in adult Kawasaki disease

Coronary artery aneurysms, stenoses, and thromboses are significant complications of Kawasaki disease (KD). While appearing in childhood, coronary complications are often left unrecognized until early and mid-adulthood. Along with the increasing capacity of noninvasive coronary artery imaging modalities, especially computed tomography and magnetic resonance, radiologists are more likely to face the diagnosis of KD in adults. This article will review the clinical aspects of KD for radiologists and will compare coronary imaging modalities in the diagnosis of KD.

Coronary artery calcium scoring in postmortem specimens. Method report

lectrocardiogram-gated coronary multislice computerized tomography (CMSCT) angiography is a rapidly improving technology allowing noninvasive imaging of coronary arteries. The diagnostic performance of this new technology allows it to be used for evaluating the presence of coronary plaques and stenosis, coronary bypass graft patency, and the origin and course of congenital coronary anomalies [1].

Integration Between Computed Tomography and Nuclear Medicine for Non-invasive Assessment of Coronary Anatomy and Myocardial Perfusion

Many non-invasive imaging techniques are available for the evaluation of patients with known or suspected coronary heart disease. Among these, computed-tomography-based techniques allow the quantification of coronary atherosclerotic calcium and non-invasive imaging of coronary arteries, whereas nuclear cardiology is the most widely used non-invasive approach for the assessment of myocardial perfusion. The available single-photon-emission computed tomography flow agents are characterised by a cardiac uptake proportional to myocardial blood flow. In addition, different positron emission tomography tracers may be used for the quantitative measurement of myocardial blood flow and coronary flow reserve. Extensive research is being performed in the development of non-invasive coronary angiography and myocardial perfusion imaging using cardiac magnetic resonance. Finally, new multimodality imaging systems have recently been developed bringing together anatomical and functional information. This article provides a description of the available non-invasive imaging techniques in the assessment of coronary anatomy and myocardial perfusion in patients with known or suspected coronary heart disease.

Left ventricular remodelling and systolic function measurement with 64 multi-slice computed tomography versus second harmonic echocardiography in patients with coronary artery disease: A double blind study

The present study evaluated LV volumes, ejection fraction (LVEF) and stroke volume (SV) obtained by 64-MDCT and to compare these data with those obtained by second harmonic 2D Echo, in patients referred for non-invasive coronary vessels evaluation. The most common technique in daily clinical practice used for determination of LV function is two-dimensional echocardiography (2D-TTE). Multi-detector computed tomography (MDCT) is an emerging new technique to detect coronary artery disease (CAD) and was recently proposed to assess LV function. 93 patients underwent to 64-MDCT for LV function and volumes assessment by segmental reconstruction algorithm (Argus) and compared with recent (2 months) 2D-TTE, all images were processed and interpreted by two observers blinded to the Echo and MDCT results. A close correlation between TTE and 64 MDCT was demonstrated for the ejection fraction LVEF ( r = 0.84), end-diastolic volume LVEDV ( r = 0.80) and end-systolic volume LVESV ( r = 0.85); acceptable correlation was recruited for stroke volume LVSV ( r = 0.58). Optimal results were recruited for inter-observer variability for 64-MDCT measured in 45 patients: LVESV ( r = 0.82, p < 0.001), LVEDV ( r = 0.83, p < 0.001), LVEF ( r = 0.69, p < 0.002) and SV ( r = 0.66, p < 0.001). Our results, showed that functional and temporal information contained in a coronary 64-MDCT study can be used to assess left ventricular (LV) systolic function and LV dimensions with good reproducibility and acceptable correlation respect to 2D-TTE. The combination of non-invasive coronary artery imaging and assessment of global LV function might became in the future a fast and conclusive cardiac work-up in patients with CAD.

Noninvasive assessment of coronary anatomy and myocardial perfusion: going toward an integrated imaging approach

Many noninvasive imaging techniques are available for the evaluation of patients with known or suspected chronic coronary artery disease. Among these, computed tomography-based techniques allow the quantification of coronary atherosclerotic calcium and noninvasive imaging of coronary arteries, whereas nuclear cardiology is the most widely used noninvasive approach for the assessment of myocardial perfusion. The available single-photon emission computed tomography flow agents are characterized by a cardiac uptake proportional to myocardial blood flow. In addition, different positron emission tomography tracers may be used for the quantitative measurement of myocardial blood flow and coronary flow reserve. Extensive research is currently being performed in the development of noninvasive coronary angiography and myocardial perfusion imaging using cardiac magnetic resonance. Finally, new multimodality imaging systems have been recently developed, bringing together anatomical and functional information. This review sought to provide a description of the relative merits of noninvasive imaging techniques in the assessment of coronary anatomy and myocardial perfusion in patients with known or suspected coronary artery disease.