Assessing the Prognostic Value of Cardiovascular Imaging

Cardiovascular imaging has become the focus of attention from both physicians and payers. The former see the potential of newer modalities to permit new and exciting insights into the diagnosis and management of coronary artery disease (CAD), that, in turn, may result in enhanced patient care strategies and new efficient clinical algorithms. On the other hand, payers have understandable concerns about the excessive use and enormous costs associated with cardiovascular imaging. These concerns have been exacerbated by the rapid expansion of the imaging devices used for the assessment of patients with known or suspected CAD. Cardiovascular stress imaging has long been the domain of stress single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) and stress echocardiography wall motion studies. At present, stress positron emission tomography (PET) MPI, cardiac computed tomography coronary angiography (CTA) (and, possibly, stress CT MPI), as well as cardiac magnetic resonance imaging (CMR) MPI and wall motion studies are utilized in daily practice. Whether all of these modalities will be reimbursed in the future is uncertain, but little doubt remains that their rigorous validation will be compulsory.Article see p 1390 Cardiac magnetic resonance imaging is an evolving technique with growing indications within the clinical cardiology setting. Whereas late gadolinium enhancement (LGE) has gained acceptance as an accurate approach for viability assessment, CMR stress imaging use is increasing as well. Nonetheless, stress CMR techniques are in their relative infancy, and evidence is only now beginning to accumulate justifying their use. Whereas several studies have examined the diagnostic accuracy of stress CMR, only recently have sufficient numbers of patients been collected to assess the prognostic value of this approach1–5 (Table).6 The validation of stress CMR is more complex than that of previous modalities, inasmuch as a routine study would include rest function and …