Hybrid Cardiac Imaging for Clinical Decision-Making : From Diagnosis to Prognosis

Performing any diagnostic test in medicine is always a matter of trying to get the condition of the patient diagnosed properly with the least effort, exposure, discomfort and at the same time with the lowest possible error probability. Pre-test probability is helpful but often imprecise, effectively overestimating the patient's risk profile. In a broader prevention objective, the phases of a disease, its onset, progression, and complications must be taken into account. The negative predictive value, which is so important, has in turn its main limitation in identifying the healthy patient, that is, the one who does not belong to any cluster of patients in which we would act in terms of prevention.  In coronary syndromes, the goal is instead to evaluate coronary heart disease, from mild to more extensive and significant forms. For this purpose, it is necessary to use parameters that investigate different and complementary aspects: stenosis, ischemia, the morphology ofthe atherosclerotic plaque, metabolic processes, in particular vitality and apoptosis, the presence of inflammatory processes. The possibility, already present thanks to Hybrid Imaging, of 'joining’ exams that study different aspects, will allow the patient to be increasingly characterized not only from a diagnostic point of view but also from a prognostic and personalized therapeutic choice.

Coronary artery disease is the most common and important cause of ischemic heart disease. Despite remarkable advances in its prevention and management, diagnosing the individual patient at risk of ischemic heart disease or with prior evidence of coronary artery disease remains challenging, but is essential to choosing correctly between medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting.
Patient-level diagnosis for ischemic heart disease often entails a complex integration of cardiac function and dimension features, plus per-vessel and per-lesion details on coronary anatomy. Ischemia, viability, hibernation and dysinnervation may coexist in a multidimensional fashion, further complicating appraisal and decision-making. Several diagnostic tests, with different prognostic implications, have been proposed over the decades for the diagnosis of ischemic heart disease in general and coronary artery disease in particular. These include ECG stress testing, stress echocardiography, single photon emission computed tomography, positron emission tomography, magnetic resonance imaging, and computed tomography.
Rather than being viewed as mutually exclusive alternatives, these non-invasive tests should be considered instead as useful in isolation, but much more powerful when appropriately integrated in a logic of hybrid imaging, especially when functional and anatomic details can be synthesized. This book, devoted to hybrid cardiac imaging for coronary artery disease, offers a detailed yet succinct guide to the integration of functional and anatomic tests for ischemic heart disease, making it a uniquely useful resource for physicians and other healthcare professionals managing patients with coronary artery disease, and in particular cardiologists and cardiac surgeons, with the ultimate goal of refining clinical decision-making, from diagnosis to prognosis.