Imaging the myocardial ischemic cascade

  • Arthur E. Stillman
  • Matthijs Oudkerk
  • David A. Bluemke
  • Menko Jan de Boer
  • Jens Bremerich
  • Ernest V. Garcia
  • Matthias Gutberlet
  • Pim van der Harst
  • W. Gregory Hundley
  • Michael Jerosch-Herold
  • Dirkjan Kuijpers
  • Raymond Y. Kwong
  • Eike Nagel
  • Stamatios Lerakis
  • John Oshinski
  • Jean-François Paul
  • Riemer H. J. A. Slart
  • Vinod Thourani
  • Rozemarijn Vliegenthart
  • Bernd J. Wintersperger
Review Paper


Non-invasive imaging plays a growing role in the diagnosis and management of ischemic heart disease from its earliest manifestations of endothelial dysfunction to myocardial infarction along the myocardial ischemic cascade. Experts representing the North American Society for Cardiovascular Imaging and the European Society of Cardiac Radiology have worked together to organize the role of non-invasive imaging along the framework of the ischemic cascade. The current status of non-invasive imaging for ischemic heart disease is reviewed along with the role of imaging for guiding surgical planning. The issue of cost effectiveness is also considered. Preclinical disease is primarily assessed through the coronary artery calcium score and used for risk assessment. Once the patient becomes symptomatic, other imaging tests including echocardiography, CCTA, SPECT, PET and CMR may be useful. CCTA appears to be a cost-effective gatekeeper. Post infarction CMR and PET are the preferred modalities. Imaging is increasingly used for surgical planning of patients who may require coronary artery bypass.


Coronary artery disease Ischemic heart disease Cardiac imaging 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Arthur E. Stillman
    • 1
  • Matthijs Oudkerk
    • 2
  • David A. Bluemke
    • 3
  • Menko Jan de Boer
    • 4
  • Jens Bremerich
    • 5
  • Ernest V. Garcia
    • 1
  • Matthias Gutberlet
    • 6
  • Pim van der Harst
    • 7
  • W. Gregory Hundley
    • 8
  • Michael Jerosch-Herold
    • 9
  • Dirkjan Kuijpers
    • 10
  • Raymond Y. Kwong
    • 11
  • Eike Nagel
    • 12
  • Stamatios Lerakis
    • 13
  • John Oshinski
    • 1
  • Jean-François Paul
    • 14
  • Riemer H. J. A. Slart
    • 15
  • Vinod Thourani
    • 16
  • Rozemarijn Vliegenthart
    • 17
  • Bernd J. Wintersperger
    • 18
  1. 1.Department of Radiology and Imaging SciencesEmory UniversityAtlantaUSA
  2. 2.Center of Medical ImagingUniversity Medical Center GroningenGroningenThe Netherlands
  3. 3.Department of Radiology and Imaging SciencesNational Institute of Biomedical Imaging and BioengineeringBethesdaUSA
  4. 4.Department of CardiologyRadboud University Medical Center NijmegenNijmegenThe Netherlands
  5. 5.Department of RadiologyUniversity of Basel HospitalBaselSwitzerland
  6. 6.Diagnostic and Interventional RadiologyUniversity Hospital LeipzigLeipzigGermany
  7. 7.Department of GeneticsUniversity Medical Center GroningenGroningenThe Netherlands
  8. 8.Departments of Internal Medicine & RadiologyWake Forest UniversityWinston-SalemUSA
  9. 9.Department of RadiologyBrigham and Women’s HospitalBostonUSA
  10. 10.Department of RadiologyHaaglanden Medical CenterThe HagueThe Netherlands
  11. 11.Department of CardiologyBrigham and Women’s HospitalBostonUSA
  12. 12.Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular ImagingUniversity HospitalFrankfurt/MainGermany
  13. 13.Department of MedicineEmory UniversityAtlantaUSA
  14. 14.Department of RadiologyInstitut Mutualiste MontsourisParisFrance
  15. 15.Department of Nuclear Medicine and Molecular Imaging, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
  16. 16.Department of Cardiac Surgery, MedStar Heart and Vascular InstituteGeorgetown UniversityWashingtonUSA
  17. 17.Department of RadiologyUniversity Medical Center GroningenGroningenThe Netherlands
  18. 18.Department of Medical ImagingUniversity of TorontoTorontoCanada

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