Role of imaging in assessment of ischemic heart disease

We review recent advances in cardiac imaging for the evaluation of patients with ischemic heart disease. Noninvasive imaging modalities discussed include radionuclide perfusion imaging, new applications of echocardiography, metabolic imaging with positron-emission tomography, and magnetic resonance imaging and ultrafast computed tomography. New clinical applications in radionuclide perfusion imaging include prognostic assessment of normal perfusion scans in patients who do and do not reach target heart rate, new pharmacologic stress modalities including dobutamine stress and adenosine vasodilation, and improved assessment of patients with left bundle branch block using pharmacologic stress. In addition, new radiotracers, technical considerations, and new imaging protocols are discussed. Assessment of myocardial viability using conventional radionuclide perfusion imaging agents, positron-emission tomography, and echocardiographic techniques is reviewed. Cine magnetic resonance imaging and ultrafast computed tomography are evolving technologies; their application to the noninvasive diagnosis of coronary artery disease has received recent attention.