Ischemic Heart Disease: Noninvasive Imaging Techniques and Findings

Abstract

Ischemic heart disease is a leading cause of death worldwide and comprises a large proportion of annual health care expenditure. Management of ischemic heart disease is now best guided by the physiologic significance of coronary artery stenosis. Invasive coronary angiography is the standard for diagnosing coronary artery stenosis. However, it is expensive and has risks including vascular access site complications and contrast material-induced nephropathy. Invasive coronary angiography requires fractional flow reserve (FFR) measurement to determine the physiologic significance of a coronary artery stenosis. Multiple noninvasive cardiac imaging modalities can also anatomically delineate or functionally assess for significant coronary artery stenosis, as well as detect the presence of myocardial infarction (MI). While coronary CT angiography can help assess the degree of anatomic stenosis, its inability to assess the physiologic significance of lesions limits its specificity. Physiologic significance of coronary artery stenosis can be determined by cardiac MR vasodilator or dobutamine stress imaging, CT stress perfusion imaging, FFR CT, PET myocardial perfusion imaging (MPI), SPECT MPI, and stress echocardiography. Clinically unrecognized MI, another clear indicator of physiologically significant coronary artery disease, is relatively common and is best evaluated with cardiac MRI. The authors illustrate the spectrum of imaging findings of ischemic heart disease (coronary artery disease, myocardial ischemia, and MI); highlight the advantages and disadvantages of the various noninvasive imaging methods used to assess ischemic heart disease, as illustrated by recent clinical trials; and summarize current indications and contraindications for noninvasive imaging techniques for detection of ischemic heart disease.Online supplemental material is available for this article.

Systematic review of efficacy of direct oral anticoagulants and vitamin K antagonists in left ventricular thrombus

“…We also performed subgroup analyses according to the region (North America, Europe, East Asia, and Middle East regions and Africa) or aetiology (ischaemic heart disease IHD, proportion >50%). IHD is defined by the incidence of coronary artery disease (CAD), myocardial ischaemia, and myocardial infarction (MI), including its complications 42 …”

“…IHD is defined by the incidence of coronary artery disease (CAD), myocardial ischaemia, and myocardial infarction (MI), including its complications. 42 …”

Albumin-templated manganese carbonate nanoparticles for precise magnetic resonance imaging of acute myocardial infarction

“…4 Current imaging techniques, such as echocardiography, positron emission tomography, and single-photon emission computed tomography can well characterize cardiac morphofunctionality and metabolism, but with risk of ionizing radiation and struggling to accurately evaluate the most important determinant of MI-caused morbidity-myocardial viability. 5 Among the noninvasive and nonionized imaging techniques, MRI is widely used for quantification of myocardial volumes, functions, and metabolism due to its high spatial resolution and deep tissue penetration. 6 More importantly, it is the accepted gold-standard method for measuring myocardial viability by delayed-enhancement MRI with contrast agent.…”

“…4 Current imaging techniques, such as echocardiography, positron emission tomography, and single-photon emission computed tomography can well characterize cardiac morpho-functionality and metabolism, but with risk of ionizing radiation and struggling to accurately evaluate the most important determinant of MI-caused morbidity--myocardial viability. 5…”

The value of CMR Left ventricular strain analysis in evaluating ICM

“…Therefore, early diagnosis of ICM has great clinical signi cance. CMR which can provide imaging evidence for myocardial ischemia has become the gold standard for evaluating cardiac structure and function due to its advantages of high soft tissue resolution, multi-parameter imaging and no radiation [3,4]. Myocardial strain analysis is an emerging CMR technology, which can quantitatively analyze left ventricular compliance and show changes in left cardiac function in ICM patients prior to Ejection fraction (EF) [5][6][7][8].…”