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Imaging the myocardial ischemic cascade
Authors: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
Institution:1.Department of Radiology and Imaging Sciences,Emory University,Atlanta,USA;2.Center of Medical Imaging,University Medical Center Groningen,Groningen,The Netherlands;3.Department of Radiology and Imaging Sciences,National Institute of Biomedical Imaging and Bioengineering,Bethesda,USA;4.Department of Cardiology,Radboud University Medical Center Nijmegen,Nijmegen,The Netherlands;5.Department of Radiology,University of Basel Hospital,Basel,Switzerland;6.Diagnostic and Interventional Radiology,University Hospital Leipzig,Leipzig,Germany;7.Department of Genetics,University Medical Center Groningen,Groningen,The Netherlands;8.Departments of Internal Medicine & Radiology,Wake Forest University,Winston-Salem,USA;9.Department of Radiology,Brigham and Women’s Hospital,Boston,USA;10.Department of Radiology,Haaglanden Medical Center,The Hague,The Netherlands;11.Department of Cardiology,Brigham and Women’s Hospital,Boston,USA;12.Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging,University Hospital,Frankfurt/Main,Germany;13.Department of Medicine,Emory University,Atlanta,USA;14.Department of Radiology,Institut Mutualiste Montsouris,Paris,France;15.Department of Nuclear Medicine and Molecular Imaging, University of Groningen,University Medical Center Groningen,Groningen,The Netherlands;16.Department of Cardiac Surgery, MedStar Heart and Vascular Institute,Georgetown University,Washington,USA;17.Department of Radiology,University Medical Center Groningen,Groningen,The Netherlands;18.Department of Medical Imaging,University of Toronto,Toronto,Canada
Abstract: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.
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