Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities.
Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.
Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA.
Nishtha
N
Sareen
Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI, 48202, USA. kananth1@hfhs.org.
Karthik
K
Ananthasubramaniam
D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013673:Technology Assessment, Biomedical; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
Left main disease; multivessel coronary disease; positron emission tomography; single photon emission computed tomography; stress echocardiography