Cardiovascular imaging to risk-stratify in chronic angina

The location, extent, and severity of obstructive coronary artery disease impact cardiovascular risk and mortality in independent and profound ways. Cardiovascular imaging modalities allow physicians to better define the anatomy and physiology of coronary obstructive disease. Conventional coronary angiography remains the most commonly used modality to define coronary anatomy. Computed tomography coronary angiography represents an important innovation, particularly by allowing coronary anatomy to be assessed in a noninvasive fashion. Stress myocardial perfusion imaging with single-photon emission computed tomography is a valuable prognostic tool. Stress testing, echocardiography, and stress myocardial radionuclide perfusion can all play important roles in risk stratification. Stress echocardiography is particularly useful in the clinic, due to the relatively low cost of equipment acquisition and the ability to image without exposure to radiation. The emerging modality of cardiac positron emission tomography offers the prospect of improved resolution, accurate quantification of blood flow, and shorter examination times.