Is there a preventive value in non-invasive cardiac imaging? Debate on the case of a marathon runner

A 64-year old male marathon runner noted during training an asymptomatic sudden increase in heart rate as recorded on his heart rate monitor. But this was not verifiable on subsequent Holter-ECG monitoring. However, treadmill exercise testing revealed unexpected signs of ischemia, which required further diagnostic tests.

Cardiac computed tomography (CT) demonstrated advanced coronary atherosclerosis, with suspected morphologically significant stenosis after contrast injection. Because of the absence of angina, a myocardial perfusion scintigraphy was done which gave no evidence of ischemia, and there was no late enhancement on magnetic resonance imaging. In view of these findings invasive coronary angiography was not performed.

The patient received aggressive risk modifying therapy. He is still running regularly event-free after nine months.

This case shows that the use of modern non-invasive cardiovascular imaging can have an impact in preventive clinical decision making.