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Choosing Appropriate Imaging Techniques

Chapter

Abstract

There is no single algorithm for choosing among myriad cardiac imaging tests. Suspected or confirmed epicardial coronary artery stenoses are typically evaluated directly by X-ray angiography in settings where revascularization is under consideration or when the pretest likelihood of disease is sufficiently high to warrant bypassing less invasive indirect testing of coronary perfusion (i.e., treadmill stress electrocardiography, stress echocardiography, or myocardial perfusion imaging.) As the pathophysiologic model of acute coronary syndromes continues to evolve, more attention will focus on early detection of nonstenotic but high-risk “vulnerable” atheromatous plaques. CT, cardiac MRI, intravascular ultrasound, and nuclear imaging techniques will continue to evolve for the purpose of coronary plaque characterization and risk stratification.

Myocardial and valvular disorders, including myocardial tissue abnormalities and systolic and diastolic dysfunction, are best imaged by techniques that provide both structural and functional (i.e., hemodynamic) information. While 2-D echocardiography with Doppler imaging is currently the standard for assessing myocardial and valvular function, cardiac MR techniques may develop into a new “gold standard” for measuring systolic function. 3-D echocardiography has great potential. Invasive measurement of intracardiac pressures by right heart catheterization is reserved for cases in which noninvasive testing yields inconclusive results or results discrepant with clinical findings.

Keywords

Acute Coronary Syndrome Myocardial Perfusion Imaging Coronary Artery Calcium Infective Endocarditis Aortic Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Gianrossi R, Detrano R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989;80(1):87.PubMedCrossRefGoogle Scholar
  2. 2.
    Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation. 1999;99:2829–48.PubMedCrossRefGoogle Scholar
  3. 3.
    Metz LD, Beattie M, Hom R, et al. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007;49(2):227.PubMedCrossRefGoogle Scholar
  4. 4.
    Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease. J Am Coll Cardiol. 2008;52(21):1724–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.PubMedCrossRefGoogle Scholar
  6. 6.
    Min JK, Dunning A, Lin FY, et al. Age- and sex- related differences in all-cause mortality risk based on coronary computed tomography angiography findings. Results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol. 2011;58(8):849–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Taylor AJ, Cerquiera M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56(22):1864–94.PubMedCrossRefGoogle Scholar
  8. 8.
    Jakobs TF, Becker CR, Ohnesorge B, et al. Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur Radiol. 2002;12:1081.PubMedCrossRefGoogle Scholar
  9. 9.
    Earls JP, Berman EL, Urban BA, et al. Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology. 2008;246:742.PubMedCrossRefGoogle Scholar
  10. 10.
    Arad Y, Spadaro LA, Roth M, et al. Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial. J Am Coll Cardiol. 2005;46(1):166.PubMedCrossRefGoogle Scholar
  11. 11.
    Schmermund A, Achenbach S, Budde T, et al. Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months: a multicenter, randomized, double-blind trial. Circulation. 2006;113(3):427.PubMedCrossRefGoogle Scholar
  12. 12.
    Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC committee to revise the 1995 guidelines for the clinical use of cardiac radionuclide imaging). J Am Coll Cardiol. 2003;42:1318–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Bonow RO, Maurer G, Lee KL, et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011;364(17):1617–25.PubMedCrossRefGoogle Scholar
  14. 14.
    Hunt SA, Abraham WT, Chin MH, et al. Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. Circulation. 2009;199:e391–479.Google Scholar
  15. 15.
    Kiser JW, Drane WE, Mastin ST, Nicole MW. Prediction of myocardial viability: Tl-201 versus sestamibi versus teboroxime compared with FDG uptake. Clin Nucl Med. 1998;23(7):432–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging – executive summary. Circulation. 2003;108:1404–18.PubMedCrossRefGoogle Scholar
  17. 17.
    Fieno DS, Kim RJ, Chen EL, et al. Contrast-enhanced magnetic resonance imaging of myocardium at risk: distinction between reversible and irreversible injury throughout infarct healing. J Am Coll Cardiol. 2000;36(6):1985.PubMedCrossRefGoogle Scholar
  18. 18.
    Bourque JM, Charlton GT, Holland BH, et al. Prognosis in patients achieving ≥10 METS on exercise testing: was SPECT imaging useful? J Nucl Cardiol. 2011;18:230–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Bourque JM, Holland BH, Watson DD, Beller GA. Achieving an exercise workload of ≥10 metabolic equivalents predicts a very low risk of inducible ischemia: does myocardial perfusion imaging have a role? J Am Coll Cardiol. 2009;54(6):538–45.PubMedCrossRefGoogle Scholar
  20. 20.
    Wright RS, Anderson JL, Adams CD, et al. ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non-ST elevation myocardial infarction (updating the 2007 guideline). J Am Coll Cardiol. 2011;57(19):1920–59.PubMedCrossRefGoogle Scholar
  21. 21.
    Hoffman U et al. Coronary computed tomography angiography for early triage of patients with acute chest pain. J Am Coll Cardiol. 2009;53:1642–50.CrossRefGoogle Scholar
  22. 22.
    Antman EM, Cohen M, Bemink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835–42.PubMedCrossRefGoogle Scholar
  23. 23.
    Ramani K, Judd RM, Holly TA, et al. Contrast magnetic resonance imaging in the assessment of myocardial viability in patients with stable coronary artery disease and left ventricular dysfunction. Circulation. 1998;98:2687–94.PubMedCrossRefGoogle Scholar
  24. 24.
    Martinez JE, Mohiaddin RH, Cilner PJ, et al. Obstruction in extracardiac ventriculopulmonary conduits: value of nuclear magnetic resonance imaging with velocity mapping and Doppler echocardiography. J Am Coll Cardiol. 1992;20:338–44.PubMedCrossRefGoogle Scholar
  25. 25.
    Askenazi I, Ahnberg DS, Komeold E, et al. Quantitative radionuclide angiocardiography: detection and quantitation of left to right shunts. Am J Cardiol. 1976;37:382–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Douglas PS, Khandheria B, Stainback RF, et al. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography. J Am Coll Cardiol. 2007;50:187–204.PubMedCrossRefGoogle Scholar
  27. 27.
    Hatle LK, Appleton CP, Popp RL. Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation. 1989;79:357–70.PubMedCrossRefGoogle Scholar
  28. 28.
    Sechtem U, Higgins CB, Sommerhoff BA, et al. Magnetic resonance imaging of restrictive cardiomyopathy. Am J Cardiol. 1987;59:480–2.PubMedCrossRefGoogle Scholar
  29. 29.
    Sutton FJ, Whitley NO, Applefeld MM. The role of echocardiography and computed tomography in the evaluation of constrictive pericarditis. Am Heart J. 1985;109:350–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113:1807.PubMedCrossRefGoogle Scholar
  31. 31.
    Pattynarna PM, Lamb HI, Van der Velde EA, et al. Reproducibility of MRI-derived measurements of right ventricular volumes and myocardial mass. Magn Reson Imaging. 1995;13:53–63.CrossRefGoogle Scholar
  32. 32.
    Marcus FL et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121(13):1533.PubMedCrossRefGoogle Scholar
  33. 33.
    Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol. 1998;32:865–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Paelinck BP, Lamb HI, Bax JJ, et al. Assessment of diastolic function by cardiovascular magnetic resonance. Am Heart J. 2002;144:198–205.PubMedCrossRefGoogle Scholar
  35. 35.
    Nienaber CA, Powell JT. Management of acute aortic syndromes. Eur Heart J. 2012;33:26–35.PubMedCrossRefGoogle Scholar
  36. 36.
    Hagan PG et al. The international registry of acute aortic dissection (IRAD) – new insights into an old disease. JAMA. 2000;283:897–903.PubMedCrossRefGoogle Scholar
  37. 37.
    Skorton DJ, Brundage BH, Schelbert HR, Wolf GL. Relative merits of technical imaging techniques. In: Braunwald E, editor. Heart disease. Philadelphia: W. B. Saunders; 1997. p. 354.Google Scholar

Recommended Reading

  1. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835–42.PubMedCrossRefGoogle Scholar
  2. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation. 2002;106:1883–92.PubMedCrossRefGoogle Scholar
  3. Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation. 1999;99:2829–48.PubMedCrossRefGoogle Scholar
  4. Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC committee to revise the 1995 guidelines for the clinical use of cardiac radionuclide imaging). J Am Coll Cardiol. 2003;42:1318–33.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of CardiologyMount Sinai Medical CenterNew YorkUSA
  2. 2.Department of CardiologyMount Sinai Medical CenterNew YorkUSA

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