Non-invasive imaging for coronary disease

Summary

Imaging is useful to confirm the diagnosis of coronary artery disease and to guide therapy in patients with intermediate pre-test likelihood of disease. This chapter gives an overview of the indications, special features and diagnostic performance of different imaging modalities in the detection of coronary artery disease. Computed tomography angiography can visualise coronary stenosis at high resolution and reliably rule out the presence of significant coronary artery disease. However, evaluation of the haemodynamic significance of coronary artery disease is difficult based on anatomy alone. Therefore, demonstration of myocardial ischaemia with the use of echocardiography, cardiac magnetic resonance imaging, and myocardial perfusion imaging is important to identify patients who can benefit from revascularisation. Many non-invasive methods can also detect dysfunctional, but viable myocardium and identify patients who are most likely to benefit from coronary revascularisation.

Introduction

During recent years the techniques for non-invasive cardiac imaging have developed rapidly. Several alternative techniques with their unique strengths and limitations are available. Diagnostic tests of coronary artery disease focus on the detection of obstructive disease, which causes myocardial ischemia and symptoms of angina pectoris. The most well-established non-invasive techniques for evaluation of coronary artery disease (CAD) are stress echocardiography and myocardial perfusion...