Non-invasive investigations

Abstract

The most commonly used techniques for imaging the effects of coronary artery disease (CAD) on the heart are myocardial perfusion scintigraphy (MPS) and echocardiography. Both tests have been validated during exercise and pharmacological stress and they are valuable for the diagnosis and aiding management decisions in patients with suspected or known CAD. In a proportion of these patients, repetitive episodes of myocardial ischaemia can lead to intracellular and extracellular changes so that myocytes, although viable, have insufficient energy to sustain contraction. This phenomenon is known as myocardial hibernation and it can be detected accurately by both MPS and stress echocardiography. The review that follows highlights the role of these techniques as powerful diagnostic and prognostic tools in clinical cardiology. In order to make the best use of them, attention to detail and planning are required to design the test to suit the clinical problem and to obtain the most accurate data possible.