The role of noninvasive imaging in coronary artery disease detection, prognosis, and clinical decision making.
A vast array of noninvasive imaging modalities is available for the evaluation of the presence and severity of coronary artery disease (CAD). Choosing the right test can be challenging but is critical for proper patient diagnosis and management. Presently available imaging tests for CAD include: (1) nuclear myocardial perfusion imaging procedures (single-photon emission tomography) and positron emission tomography, (2) stress echocardiography, (3) computed tomography coronary angiography, and (4) cardiac magnetic resonance imaging. Exercise treadmill testing electrocardiography is another alternative that we will discuss briefly. Selection of the most appropriate imaging modality requires knowledge of the clinical question being addressed, patient characteristics (pretest probability and prevalence of disease), the strengths, limitations, risks, costs, and availability of each procedure. To assist with test selection, we review the relevant literature in detail to consider the relative merits of cardiac imaging modalities for: (1) detection of CAD, (2) risk stratification and prognostication, and (3) guiding clinical decision making.
University of Ottawa Heart Institute, Department of Medicine (Cardiology), Ottawa, Ontario, Canada.
Taylor
T
Dowsley
Mouaz
M
Al-Mallah
Karthik
K
Ananthasubramaniam
Girish
G
Dwivedi
Brian
B
McArdle
Benjamin J W
BJ
Chow
D000465:Algorithms; D057791:Cardiac Imaging Techniques; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy*; D003952:Diagnostic Imaging / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods; D018579:Patient Selection; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods