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Non-invasive anatomy and physiology: the new ‘gold standard’?
  1. William Chadwick Wood
  1. Correspondence to William Chadwick Wood, Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Brody School of Medicine, Mail Stop 651, East Carolina University, Greenville, NC 27834-4354, USA; woodw{at}ecu.edu

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“Do not quench your inspiration and your imagination; do not become the slave of your model.”

Vincent van Gogh1

Rapid progress in the fields of interventional cardiology and in the non-invasive assessment of coronary anatomy by multislice computed tomography (MSCT) have created enormous challenges to define the proper use of a modality (MSCT) which is non-invasive, but subjects patients to angiographic risks of contrast administration and radiation exposure. Technological improvement of a second non-invasive imaging modality, magnetic resonance myocardial perfusion imaging (MRPI), has advanced considerably, although perhaps not at the rapid and accelerating rate of MSCT. The question now arises as to what is the ‘gold standard’ to which patients should be compared to best define whether interventional treatment (coronary artery bypass grafting and/or percutaneous catheter intervention) with medical treatment or medical management without intervention for coronary stenosis should be chosen for the individual patient.

Making these decisions even more complex is the fact that coronary artery disease has many presentations, including clinical syndromes related to chronic coronary arterial stenosis or acute coronary syndromes associated with plaque rupture. Current non-invasive testing methods include treadmill, echocardiographic and nuclear stress modalities and have been based on the assumptions that electrocardiographic changes, left ventricular wall motion abnormalities and myocardial perfusion defects in SPECT myocardial imaging can be provoked in a significant number of patients, and these abnormalities can, in turn, identify individual patients who might benefit from specific treatment.

In this issue of this journal, van Werkhoven and colleagues compare findings on MSCT study with MRPI study findings and with catheter angiographic study of the coronary artery …

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