Arq Bras Cardiol: Imagem cardiovasc. 2024; 37(2): e20240037

Assessment of Myocardial Ischemia with the Integrated Use of Multimodality Imaging

Thiago Nunes Pereira

Leite

, Luís Henrique Wolff

Gowdak

DOI: 10.36660/abcimg.20240037i

Abstract

Myocardial ischemia, which is characterized by reduced oxygen supply to the myocardium, is a common manifestation of coronary artery disease (CAD), one of the leading causes of morbidity and mortality worldwide. Early and accurate detection of myocardial ischemia is essential for risk stratification, treatment planning, and improved clinical outcomes. In recent years, advances in cardiac imaging modalities have provided a more comprehensive assessment of myocardial ischemia. This article reviews recent advances in the assessment and detection of myocardial ischemia with a focus on the integrated use of multimodality imaging. The article discusses the main techniques available, their advantages and limitations, and their role in current clinical practice, in addition to future perspectives in this area. Cardiac imaging modalities for assessment of myocardial ischemia include exercise electrocardiography, stress echocardiography, single-photon emission computed tomography, positron emission tomography, cardiac magnetic resonance imaging, and coronary computed tomography angiography. When selected imaging tests, it is necessary to consider the pre-test probability (PTP) of CAD and patients’ clinical characteristics. Non-invasive functional modalities are preferable for patients with intermediate probability of CAD. The integration of these modalities can improve sensitivity, specificity, and diagnostic accuracy, offering a more complete assessment of the patient’s cardiovascular condition and allowing for more personalized therapeutic planning.

In conclusion, the multimodal approach to myocardial ischemia assessment improves early detection, risk stratification, and therapeutic planning. The combination of several imaging modalities allows a holistic view of the cardiovascular condition, improving diagnostic accuracy and clinical outcomes in patients with suspected or established diagnosis of CAD.