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Noninvasive Assessment of Asymptomatic Individuals at Risk of Coronary Heart Disease. Part b

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Noninvasive Imaging of Myocardial Ischemia

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7. Conclusion

Echocardiography provides useful information for high-risk asymptomatic patients. When combined with stress, a powerful prognostic tool is available that can unmask previously undiagnosed CAD. The application of this to screening is constrained by overall low disease probability in unselected asymptomatic patients, but the use of clinical tools, such as the Framingham risk score, can define a subgroup, which will be enriched with high-risk individuals.

We have examined the role of SE and other imaging modalities in various high-risk subgroups. Overall, SE seems to have a good predictive value comparable to that of MPS and in certain cases may avoid the need for coronary angiography. For those who have abnormalities on a noninvasive imaging test and are asymptomatic, a management plan needs to be defined. This includes a choice of addressing cardiac risk factors, or invasive assessment of coronary anatomy by angiography with a view to possible revascularization if necessary. In many of the high-risk subgroups we have discussed, the decision to proceed to revascularization is hampered by the lack of large randomized trials to support this approach. Although SE and MPS can provide prognostic data in high-risk subgroups, further clarification with multicenter studies is required to assess under what circumstances revascularization can alter prognosis in high-risk patients who are truly asymptomatic.

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Authors and Affiliations

  1. Princess Alexandra Hospital, University of Queensland, Brisbane, Australia

    Dhrubo Rakhit MD & Thomas H. Marwick MBBS, PhD, FRACP, FACC

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  1. Dhrubo Rakhit MD
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  2. Thomas H. Marwick MBBS, PhD, FRACP, FACC
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Editors and Affiliations

  1. Royal Brompton Hospital, London, UK

    Constantinos D Anagnostopoulos MD, PhD, FRCR, FESC

  2. Chelsea & Westminster Hospital, London, UK

    Constantinos D Anagnostopoulos MD, PhD, FRCR, FESC

  3. Imperial College School of Medicine, National Heart and Lung Institute, London, UK

    Constantinos D Anagnostopoulos MD, PhD, FRCR, FESC

  4. Hammersmith Hospital, Imperial College, London, UK

    Petros Nihoyannopoulos MD, FRCP, FACC, FESC

  5. Leiden University Medical Center, Leiden, The Netherlands

    Jeroen J. Bax MD, PhD  & Ernst van der Wall MD, FESC, FACC  & 

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Rakhit, D., Marwick, T.H. (2006). Noninvasive Assessment of Asymptomatic Individuals at Risk of Coronary Heart Disease. Part b. In: Anagnostopoulos, C.D., Nihoyannopoulos, P., Bax, J.J., van der Wall, E. (eds) Noninvasive Imaging of Myocardial Ischemia. Springer, London. https://doi.org/10.1007/1-84628-156-3_9

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