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Invasive and non-invasive cardiovascular multimodality imaging in ischaemic heart disease

ESC Congress Report

  • Class I recommendation for FFR in lesions without non invasive evidence of ischemia.
  • Expert predicts that PET/MRI will be the best method for viability assessment.
  • PET-CT has promising results for viability in first human studies.

View the Slides from this session in ESC Congress 365

The session addressed the role of advanced and innovative invasive and non invasive multimodality cardiac imaging in the assessment and management of patients with ischemic heart disease.

Dr. Luisa Salido Tahoce (Madrid, ES) started the session by highlighting some of the invasive tools. He reminded the audience that the current ESC guidelines recommend FFR for the assessment of intermediate lesions in patients without objective evidence of vessel-related myocardial ischemia (Class I, level of evidence A). In these cases, physiology guided PCI with FFR is the standard to evaluate if a stenosis is significant. However, the evidence for FFR comes mainly from patients with stable angina. In patients with acute coronary syndrome (ACS), other imaging modalities, like OCT which has excellent resolution, may be needed. Moreover, OCT allows for the identification of the culprit lesion which may be important in patients with ACS.

Dr. Thomas Schindler (Baltimore, US) reported on the role of PET and MRI in the assessment of myocardial viability. According to Dr Schindler, both techniques provide excellent and accurate assessment of viability. In addition, both techniques have prognostic data demonstrating the ability to predict functional recovery. Thus, Dr. Schindler believes that Integrated PET/MRI is likely to evolve as the reference imaging modality in cardiac viability assessment. However, the current data is limited and further studies are needed.

Continuing with the theme of innovative technology, Dr. Aliessa Gimelli (Pisa, IT) showed that the new ultrafast SPECT systems are at least as accurate as the conventional SPECT systems, with the added benefit of being much faster with much lower radiation exposure. Some patients can be scanned with doses less than 1 millisievert (mSv). She explained that these new systems may provide the possibility to quantify myocardial blood flow using SPECT imaging and that preliminary data appears to be promising.

Finally, Prof. Grigorios Korosoglou (Heidelberg, GE) reviewed the invasive and non invasive techniques for arterial vulnerable plaque imaging. He suggested that cardiac MR has tremendous potential as a research tool and may be optimally suited for serial studies. He also mentioned that the combination of CT with nuclear techniques (18F-NaF PET-CT) showed very promising results in the first human studies.

In summary, many innovative tools are starting to penetrate the clinical arena and will be used more often. Precise understanding of the role of these techniques (PET/MR, ultrafast SPECT and plaque imaging by MRI, coronary CTA and 18F-NaF PET-CT) and their incremental diagnostic and prognostic value is currently investigated and will shed further light on the utility of these tools.   




Invasive and non-invasive cardiovascular multimodality imaging in ischaemic heart disease

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.