Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia

Abstract

International guidelines advocate noninvasive testing for patients with suspected ischaemia before proceeding with revascularization decision-making 1-4. Noninvasive clinical cardiac imaging continues to undergo rapid evolution, focusing on quantitative perfusion technologies for the assessment of myocardial ischaemia and coronary flow. At present, imaging of myocardial ischaemia stands at a crossroads. During a European meeting on quantitative cardiac imaging, a bench-to-bedside-to-bench perspective was used to summarize the current status and future potential of myocardial ischaemia imaging from the viewpoint of basic scientists and clinical researchers. This approach created discussions, which led to this Consensus Statement on the main advantages and disadvantages of each imaging modality, a clinical consensus on the appropriateness for specific indications and a summary of the latest developments, which together provide a framework for future quantitative imaging of myocardial ischaemia. Pathophysiology considerations The coronary circulation comprises the epicardial conductance vessels (diameter 1-6 mm) feeding an extensive network of small vessels (diameter <300-400 μm) that penetrates the cardiac muscle tissue and is the site of regulation of myocardial blood flow (MBF; Fig. 1a,b). High-resolution 3D fluorescence cryomicrotome imaging 5 has also revealed the existence of abundant small

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