Perspectives of new imaging techniques for patients with known or suspected coronary artery disease

Coronary artery disease (CAD) remains one of the leading causes of morbidity and mortality in western society. Over recent decades, major advances have been made in non invasive imaging techniques, resulting in an enormous growth in their role in the clinical assessment of patients with known and suspected CAD. Indeed, although invasive coronary angiography remains the current gold standard in the diagnosis of CAD, first-line non invasive assessment with functional techniques has become essential, particularly in patients at intermediate risk for CAD, to select those patients needing further invasive evaluation and intervention. For this purpose, nuclear imaging has since long been available, while more recently functional imaging can also be performed with stress-echocardiography (with contrast) and magnetic resonance imaging (MRI). Importantly, these techniques visualize the consequences of obstructive CAD, namely ischemia, rather than the coronary arteries directly, and the presence of atherosclerosis that is not flow limiting cannot be evaluated. For the latter purpose, non invasive coronary angiography with MRI and computed tomography techniques is under extensive investigation. The purpose of this review is to provide an overview of the non invasive imaging techniques currently available in the evaluation of CAD. Heart Metab. 2007;34:10–14.