REVIEW

Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society Working Group

A H Gershlick¹, M de Belder², J Chambers³, D Hackett⁴, R Keal⁵, A Kelion⁶, S Neubauer⁷, D J Pennell⁸, M Rothman⁹, M Signy¹⁰, P Wilde¹¹

¹ Department of Cardiology, University of Leicester, Glenfield Hospital, Leicester, UK
² James Cook University Hospital, Middlesborough, Cleveland, UK
³ Department of Cardiology, Guy’s & St Thomas’ Hospital, London, UK
⁴ Cardiology Department, Hemel Hempstead General Hospital, Hemel Hempstead, UK
⁵ Department of Radiology, Glenfield Hospital, Leicester, UK
⁶ Department of Cardiology, Harefield Hospital, Harefield, Middlesex, UK
⁷ John Radcliffe Hospital, Headington, Oxford, UK
⁸ CMR Unit, Royal Brompton Hospital, London, UK
⁹ Research & Development Office, London Chest Hospital, London, UK
¹⁰ Worthing Hospital, West Sussex, UK
¹¹ Diagnostic Radiology, Department of Clinical Radiology, Bristol Royal Infirmary, Bristol, UK

Correspondence to:
Correspondence to:
Dr A H Gershlick

Coronary angiography has been the gold standard for determining the severity, extent and prognosis of coronary atheromatous disease for the past 15–20 years. However, established non-invasive testing (such as myocardial perfusion scintigraphy and stress echocardiography) and newer imaging modalities (multi-detector x ray computed tomography and cardiovascular magnetic resonance) now need to be considered increasingly as a challenge to coronary angiography in contemporary practice. An important consideration is the degree to which appropriate use of such techniques impacts on the need for coronary angiography over the next 10–15 years. This review aims to determine the role of the various investigation techniques in the management of coronary artery disease and their resource implications, and should help determine future service provision, accepting that we are in a period of significant technological change.

Abbreviations: BCS, British Cardiovascular Society; CA, coronary angiography; CAD, coronary artery disease; CMR, cardiovascular magnetic resonance; ETT, exercise tolerance test; LV, left ventricular; MDCT, multi-detector x ray computed tomography; MPS, myocardial perfusion scintigraphy; PCI, percutaneous coronary intervention; PET, positron emission tomography; SE, stress echocardiography; SPECT, single photon emission computed tomography; SpR, specialist registrar

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