The clinician's view of cardiac diagnostic imaging

In the last 30 years, non-invasive cardiac imaging was employed for the diagnostic and prognostic assessment of patients with suspected or known coronary artery disease. Nuclear myocardial perfusion scintigraphy or stress echocardiography provide a high sensitivity and specificity in the detection of functionally significant coronary artery disease (CAD) and demonstrated incremental diagnostic and prognostic value over exercise electrocardiography and clinical variables. Recently, cardiac computed tomography has been increasingly used a non-invasive tool for the detection and quantification of coronary artery stenoses and calcifications. The increase in this technical "offer" induces a significant increase in the "demand" for non-invasive imaging assessment, with a rise in the number of imaging studies performed in the last years, which appropriateness, however, is often questionable. A critical evaluation of the use of imaging techniques in different clinical scenarios is briefly discussed.