Multimodality Non-Invasive Imaging Approach in Acute Coronary Syndrome: Diagnostic and Prognostic Assessment.

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Acute coronary syndrome (ACS) diagnosis and management present challenges.
• Differentiating ACS from other conditions requires careful selection of diagnostic tests.

Purpose of the Study:

• To review the role of non-invasive multimodal imaging in suspected ACS.
• To delineate scenarios where transthoracic echocardiography (TTE), coronary computed tomography angiography (CCTA), cardiac magnetic resonance (CMR), and nuclear imaging are optimal.

Main Methods:

• Narrative review of current evidence and guidelines.
• Analysis of non-invasive imaging techniques in ACS diagnosis.

Main Results:

• TTE identifies wall motion abnormalities; speckle tracking enhances sensitivity.
• CCTA offers high negative predictive value and plaque analysis.
• CMR aids in MINOCA diagnosis and NSTEMI work-up, with prognostic value.
• Nuclear imaging detects ischemia and infarction, supporting safe discharge.

Conclusions:

• Non-invasive imaging is valuable in low pre-test probability ACS, low-risk NSTEMI, ruling out alternatives, and MINOCA diagnosis.
• These techniques reduce unnecessary invasive coronary angiography (ICA).
• Practical recommendations aim to minimize redundant, costly, and risky procedures.