doi: 10.1161/CIRCIMAGING.109.873489
Editorials |
Anatomic and Functional Assessment of Coronary Artery Disease
Convergence of 2 Aims in a Single Setting
From the Department of Medicine and Radiology, Weill Medical College of Cornell University, The New York Presbyterian Hospital, New York, NY; the Departments of Imaging (Division of Nuclear Medicine), Department of Medicine (Division of Cardiology), and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif; and the Department of Medicine, University of California at Los Angeles, School of Medicine, Los Angeles, Calif.
Correspondence to Daniel S. Berman, MD, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room 1258, Los Angeles, CA 90048. E-mail bermand@cshs.org
Key Words: Editorials • imaging
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Between two worlds life hovers like a star, twixt night and morn, upon the horizon’s verge.— —Lord Byron
Conventional noninvasive methods of evaluation of individuals with suspected coronary artery disease (CAD) have relied on functional testing by an array of modalities, including exercise treadmill testing, stress echocardiography and myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT),1 or positron-emission tomography (PET).2 In their most commonly used applications, these modalities are useful for assessing myocardial perfusion and function at rest and in response to exercise or pharmacological intervention, providing valuable information regarding the presence or absence of obstructive CAD, future cardiac events, and predicting benefit from appropriate therapies.
Article see p 174
Among the wide range of functional imaging tests, SPECT-MPI has emerged as the most commonly used modality—accounting for nearly 90% of imaging stress tests performed in the United States each year.3 Early studies examining SPECT indicate that myocardial perfusion is reduced in the presence of a 
70% intraluminal epicardial stenosis.4 Beyond its diagnostic potential, the widespread use of SPECT-MPI stems from its robust ability for prognostic risk stratification, such that individuals with normal SPECT have very low rates of near- and intermediate-term adverse CAD events, whereas those with severely abnormal SPECT-MPI have high rates of adverse CAD events.5 Further, SPECT may identify patients who may most benefit from invasive coronary angiography (ICA) and coronary revascularization in addition to medical therapy versus those who would benefit from medical therapy alone.6,7
After early validation as a sensitive method for
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