Cardiac imaging in the evaluation of patients presenting to the emergency department with chest pain |
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Authors: | Jared J Wyrick Kevin Wei |
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Institution: | aCardiovascular Division, Oregon Health & Science University, Portland, Ore. |
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Abstract: | Conclusions Despite the utility and benefits that each imaging modality has to offer, it is easy to see why there is still no perfect
choice for a noninvasive cardiac imaging modality to assist in the management of chest pain patients. All of the current imaging
techniques have their own significant strengths and weaknesses when compared with other modalities. SPECT and echocardiography
are wellestablished technologies that can directly assess the presence of myocardial ischemia and its functional consequence
on RF; newer and more expensive techniques such as MDCT and CMR can directly assess coronary anatomy and have just started
to be evaluated in the acute chest pain setting. There are no studies that directly compare these technologies, and more data
are clearly needed before the question of whether anatomic imaging versus perfusion/function imaging is the better approach
can be answered. Other comparisons such as relative safety, availability, logistics, and cost-effectiveness between the various
technologies are also lacking.
Of all of the imaging modalities discussed, MCE is the only portable technology. The images do not require expensive software
or other technology for offline processing before interpretation, and any trained cardiologist can read the study at the bedside
or, potentially, over the Internet, providing near-instantaneous results in the acute cardiac setting, where time is of the
essence.
MCE is also relatively cheap compared with other technologies, a potential advantage for payors but not necessarily for payees.
How reimbursement rates and fee structures eventually affect clinical practice is also unknown.
Despite these and other questions that need to be answered before any one technique will be used exclusively, the future of
noninvasive cardiac imaging remains an exciting and ever-changing field. The adaptation of any one of these techniques into
its proper role in the ED Journal of Nuclear Cardiology Wyrick and Wei 753 Volume 13, Number 6;749-55 Cardiac imaging in patients
with chest pain will take considerably more time and effort in terms of research, money, and time-tested clinical experience. |
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