Key result
Non-invasive imaging techniques, including stress echocardiography, cardiac CT, and myocardial perfusion scintigraphy, are valuable for assessing ischemia and guiding the need for coronary angiography.
Why the study?
Effective management of ischemic cardiomyopathy is crucial as outlined in the latest ESC guidelines for CCS, which emphasize structured evaluation and individualized diagnostic testing.
Non-invasive imaging modalities are crucial for the patient-centered evaluation of ischemic heart disease and for optimizing the selection of candidates for invasive coronary angiography, in alignment with ESC guidelines.
Supports stepwise CCS evaluation per 2024 ESC guidelines; leaves open real-world impact on ICM outcomes.
Cardiovascular diseases, particularly ischemic heart disease (IHD), are the leading cause of mortality globally, accounting for 16% of deaths. Effective management of ischemic cardiomyopathy (ICM) is crucial, as outlined in the latest European Society of Cardiology (ESC) guidelines for chronic coronary syndrome (CCS). The guidelines emphasize a structured approach comprising four key steps: a general clinical evaluation to exclude non-cardiac causes, cardiac examination, and likelihood estimation using echocardiography, diagnostic testing such as stress echocardiography and coronary CT angiography, and treatment involving lifestyle changes and medication, alongside potential revascularization. The review underscores the importance of coronary angiography and functional assessments in diagnosing ischemic heart failure (IHF) and guiding treatment strategies. Non-invasive imaging techniques, including stress echocardiography and myocardial perfusion scintigraphy, are valuable for assessing ischemia and myocardial viability while reducing unnecessary invasive procedures. Coronary CT angiography is also examined for its procedural advantages and risks. A comparative analysis of diagnostic modalities highlights the strengths and limitations of each technique, emphasizing the need for individualized approaches based on patient characteristics. The ESC 2024 guidelines advocate for a patient-centered imaging strategy based on the likelihood of coronary artery disease (CAD) while addressing the economic and environmental impacts of imaging practices. Overall, implementing these guidelines and leveraging diverse imaging modalities can optimize management strategies for IHD, ultimately improving patient outcomes.
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Costantino et al. (2025) conducted a review in Ischemic heart disease. Non-invasive imaging modalities (stress echocardiography, cardiac CT, myocardial perfusion scintigraphy) vs. Invasive coronary angiography was evaluated. Non-invasive imaging techniques, including stress echocardiography, cardiac CT, and myocardial perfusion scintigraphy, are valuable for assessing ischemia and guiding the need for coronary angiography.
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