YEAR IN REVIEW CARDIOVASCULAR IMAGING IN 2013

FFRCT is calculated using computational fluid dynamic modelling. In 2013, Nakazato and colleagues assessed the performance of FFRCT to diagnose lesions of intermediate severity (30–69% stenosis as determined using CT).4 Patients underwent ICA and CCTA, and a total of 150 vessels of intermediate stenosis were evaluated. FFR was measured using ICA with a pressure-monitoring guidewire placed distally to the stenosis. FFR and FFRCT ≤80% was considered ischaemic, and CT stenosis ≥50% was considered obstructive. FFRCT was found to have a high diagnostic performance compared with CT for the diagnosis of ischaemia—a twofold increase in sensitivity (74% versus 34% per vessel) and a higher negative predictive value (90% versus 78% per vessel) was reported. FFRCT is one of several new applications of CCTA, with the aim of substantially improving noninvasive assessment of coronary anatomy. CCTA is likely to have an important future role in the noninvasive diagnosis of CAD. Although single-photon emission computed tomography (SPECT) is widely used in the detection of ischaemia, perfusion CMR has also been increasingly used for this purpose in clinical practice. CMR has been used on the basis of studies showing a strong diagnostic performance of CMR compared with ICA.5 Therefore, in the MR‑IMPACT II trial,6 Schwitter and colleagues compared the diagnostic performance of CMR and SPECT for the detection of CAD. This prospective trial involved 425 patients at 33 centres. ICA was used as the reference

New era of evidence-based medicine with noninvasive imaging Puskar Pattanayak and David A. Bluemke

In 2013, advances in noninvasive imaging methods pushed traditional boundaries in the detection, diagnosis, and functional assessment of coronary artery disease, atherosclerotic plaque, and myocardial function. We highlight five important studies that demonstrate how these developments are allowing medicine to become increasingly evidence‑based and personalized. Pattanayak, P. & Bluemke, D. A. Nat. Rev. Cardiol. 11, 74–76 (2014); published online 14 January 2014; doi:10.1038/nrcardio.2013.215

Diagnostic and interventional imaging meth­o ds have frequently laid the foundation for advances in the diagnosis and treatment of cardiovascular diseases. Are engineering advancements in imaging scanners pushing evidence-based medicine into a new era? Dozens of high-impact cardiac imaging articles were published in 2013. In this Year in Review article, we discuss five of the most‑important studies on noninvasive imaging. Cardiac magnetic resonance (CMR) technology has added substantially to the assessment of myocardial scarring. After injection of the routinely used contrast agent gado­ linium, bright areas of late enhancement indicate regions of myocardial scar tissue. The current dogma is that severe left ventricular wall thinning is indicative of a transmural myocardial infarction with no residual viable tissue. An end-diastolic wall thickness 7.5% at 30 years in patients with a dose of anthracycline ≥250 mg/m2 has been reported.7 Therefore, Ylanen and colleagues used CMR to evaluate the prevalence of left and right ventricular dysfunction and signs of focal fibrosis among long-term survivors of childhood cancer who had been exposed to anthracycline.8 The cohort comprised 62 patients who were in remission from cancer, and the mean age was 14.6 years. The cumulative anthracycline dose was 224 mg/m2 for girls and 184 mg/m2 for boys. Abnormal left or right ventricular function (ejection fraction

Cardiovascular imaging in 2013: New era of evidence-based medicine with noninvasive imaging.

In 2013, advances in noninvasive imaging methods pushed traditional boundaries in the detection, diagnosis, and functional assessment of coronary arte...
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