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Myocardial perfusion imaging in advanced coronary artery disease

Roel Hoek1, Pepijn A van Diemen1, Yvemarie B O Somsen1

  • 1Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

European Journal of Clinical Investigation
|March 18, 2025
PubMed

Insights

Myocardial perfusion imaging (MPI) aids in diagnosing coronary artery disease (CAD). This review examines MPI techniques like cardiac magnetic resonance (CMR), SPECT, and PET in advanced CAD cases.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Myocardial perfusion imaging (MPI) is a key noninvasive tool for detecting ischemia in suspected obstructive coronary artery disease (CAD).
  • Interpretation challenges arise in advanced CAD, influencing clinical decisions.

Purpose of the Study:

  • To review the utility of MPI techniques, including cardiac magnetic resonance (CMR) imaging, single-photon emission computed tomography (SPECT), and positron emission tomography (PET), in patients with advanced CAD.
  • To discuss factors affecting MPI interpretation, diagnostic performance for obstructive CAD and coronary microvascular dysfunction (CMD), and MPI's role in guiding revascularization.

Main Methods:

  • Review of existing literature on MPI techniques (CMR, SPECT, PET) in advanced CAD.
  • Analysis of factors impacting MPI interpretation in complex patient groups.
  • Evaluation of diagnostic performance for obstructive CAD and CMD.

Main Results:

  • MPI techniques show utility in advanced CAD, but interpretation can be complex.
  • Factors such as prior myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and chronic total occlusion (CTO) influence MPI results.
  • MPI plays a role in assessing obstructive CAD, coronary microvascular dysfunction (CMD), and guiding revascularization strategies.

Conclusions:

  • MPI, utilizing CMR, SPECT, and PET, remains valuable in advanced CAD, though interpretation requires careful consideration of patient-specific factors.
  • Understanding these factors is crucial for accurate diagnosis and effective treatment guidance, including revascularization decisions.

Keywords:
cardiac magnetic resonance imagingchronic total occlusioncoronary artery bypass graftingcoronary artery diseasecoronary microvascular dysfunctionmyocardial infarctionmyocardial perfusion imagingpercutaneous coronary interventionpositron emission tomographysingle‐photon emission computed tomography

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