Integrating anatomical and functional imaging for the assessment of coronary artery disease

Abstract

Coronary artery disease (CAD) is a leading cause of morbidity and mortality. Invasive cardiac angiography with fractional flow reserve measurement allows for the anatomical and functional assessment of CAD. Given the invasive nature of invasive cardiac angiography and the risks of procedure-related complications, research has focused upon noninvasive methods for anatomical and functional measures of CAD. As such, there is growing interest in the development of hybrid imaging because it may provide incremental diagnostic information over each imaging modality alone. We will provide an overview of the evidence to date on the anatomical and functional stratification of CAD and current hybrid techniques.

Keywords::

• anatomical imaging
• coronary artery disease
• functional imaging
• hybrid imaging

Financial & competing interests disclosure

B Chow receives research support from GE Healthcare and educational support from TeraRecon Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Noninvasive imaging may help identify the patients who need invasive cardiac angiography (ICA), specifically those who would benefit from revascularization given the invasive nature of ICA and risks of procedure-related complications.

• • Anatomical imaging includes coronary computed tomography (CT) angiography (CCTA) and magnetic resonance angiography and provides information about coronary anatomy while functional imaging includes single photon emission-CT, positron emission tomography (PET), stress echocardiography, stress MRI and CT perfusion and assesses the hemodynamic consequences of coronary artery disease (CAD).

• • CCTA acts as a possible gatekeeper to invasive diagnostic and surgical procedures.

• • Stress cardiac MRI has a role in assessment of CAD, but the role of cardiac magnetic resonance angiography is uncertain.

• • PET myocardial perfusion imaging has been shown to have significant prognostic value for predicting cardiac events including death and myocardial infarction.

• • The development of fractional flow reserve CT and being able to use noninvasive imaging to differentiate between a flow limiting and nonflow limiting lesion noninvasively is exciting as a step toward improving risk stratification of CAD.

• • Hybrid imaging such as PET/CCTA, single photo emission-CT/CCTA and PET/MRI are evolving methods of both anatomical and functional assessment of CAD, but further studies are needed to demonstrate their incremental value.

• • Further studies examining the cost-effectiveness of hybrid imaging strategies are required.