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 233 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Functional imaging in patients with suspected or known coronary artery disease (CAD) is crucial for the identification of patients who could benefit from coronary revascularization. Several studies demonstrated the high diagnostic accuracy of Single-photon-emission computed tomography myocardial perfusion imaging, stress perfusion magnetic resonance imaging, and of invasive FFR measurements for the detection of hemodynamic relevant stenosis. Cardiac computed tomography (CT) used to be limited to coronary angiography (CTA); current guidelines recommend CTA only for the exclusion of CAD. Technological advances now offer the possibility to assess myocardial perfusion by computed tomography (CT-MPI). Though different acquisition protocols and post-processing algorithms still have to be evaluated, initial clinical studies could already show a diagnostic accuracy comparable to the established imaging modalities. Thus, cardiac CT may offer a combined approach of anatomical and functional imaging. Beside the need for further studies, especially on the prognostic value of CT-MPI to stratify future cardiovascular events, the comparatively high radiation exposure and additional administration of contrast agent has to be taken in account.
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PMID:CT imaging of myocardial perfusion: possibilities and perspectives. 2347 67

Recent clinical trials directed at imaging of coronary artery disease (CAD) have demonstrated a paradigm shift away from endpoints related to detection of CAD in favor of those related to clinical outcomes. The objective of such trials has been to determine whether physiological metrics are superior to anatomical ones for guiding therapy and improving outcomes in patients with known or suspected CAD. The present review focuses on selected trials in this area in particular DEFER, FAME 1 and 2, a meta-analysis comparing FFR to anatomically guided treatment outcomes and COURAGE SPECT MPI sub study. The rationale for using physiological as opposed to anatomical endpoints to optimize patient management, in particular coronary revascularization decisions, is emphasized. The results of the FFR-based trials are concordant and indicate physiological metrics are superior to anatomical ones for guiding therapy and improving clinical outcomes in patients with known or suspected CAD.
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PMID:Functional Versus Anatomic Imaging of CAD: Lessons Learned from Recent Clinical Trials. 2669 31