From Echo to Coronary Angiography: Optimizing Ischemia Evaluation Through Multimodal Imaging

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Techniques

Background:

• Myocardial ischemia evaluation relies on a range of imaging modalities.
• Each technique offers unique strengths for assessing coronary artery disease.
• Current guidelines recommend specific imaging based on patient risk stratification.

Purpose of the Study:

• To review the roles of multimodal imaging in myocardial ischemia.
• To highlight the complementary nature of noninvasive and invasive techniques.
• To guide optimal modality selection for patient-centered care.

Main Methods:

• Review of echocardiography, cardiac magnetic resonance imaging (CMR), SPECT, PET, and invasive coronary angiography (ICA).
• Discussion of coronary computed tomography angiography (CCTA) for risk stratification.
• Emphasis on adjunctive invasive hemodynamic and provocative testing.

Main Results:

• Noninvasive functional imaging suits intermediate-to-high pre-test probability patients; CCTA for low-to-intermediate risk.
• Stress echocardiography detects wall motion abnormalities; CMR quantifies myocardial blood flow (MBF).
• SPECT/PET quantify ischemic burden; PET excels in MBF and microvascular disease assessment.

Conclusions:

• ICA is the gold standard for epicardial stenosis but requires adjunctive tests for functional significance.
• Individualized modality selection based on patient factors and data needs is crucial.
• Integrated multimodal imaging provides a comprehensive approach to ischemia evaluation.