Prof. Eike Nagel,
The session provided a good overview on currently available technologies for risk assessment with imaging technologies.
Dr. I.M. Graham (Dublin, IE) challenged the utilization of imaging technologies or other additional risk markers relative to the established markers (e.g. in SCORE) as the additional information is relatively low. However, they can be used to change the “risk age” and also to reclassify patients, which are on the border zone between a risk requiring treatment and no treatment yet. As examples CIMT and HDL were discussed.
Dr. E. de Groot (Amsterdam, NL) then updated the audience on the value of CIMT for risk assessment. As a major advantage of this approach, he stressed the availability of different normal values for different age groups. It is important to remember however that the visualization of a carotid plaque places the patient in a different risk group altogether and makes the assessment of CIMT obsolete.
Dr. B. Shivalkar (Edegem, BE) then changed the subject more towards the use of CT technologies, such as CTA and calcium scoring in a wide range of diseases, such as acute chest pain, triple rule out and exclusion of coronary artery disease in patients with stable and unstable angina. The value of coronary calcium as an independent risk factor was stressed.
Finally, Dr. Bruder (Essen, DE) summarized the results of the Euro-CMR registry showing that magnetic resonance imaging is used adequately, leads to a change of treatment or a different diagnosis in a majority of patients, and is very safe. CMR is now an established technique for detecting myocardial infarction, determining the etiology of heart failure and to prove or exclude the presence of myocardial ischaemia with high accuracy and good prognostic value. Dr. Bruder also provided some preliminary data on cost-effectiveness of CMR in clinical routine. To summarize the session, none of the imaging techniques should be used for screening. However, when used in the appropriate patient population, they are excellently suited to prove or exclude disease. The cost-effectiveness of these approaches still needs to be evaluated in future studies.
Imaging in preventive cardiology: indication and cost effectiveness
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