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Noninvasive cardiac imaging in suspected acute coronary syndrome

Nature Reviews Cardiology volume 13, pages 266–275 (2016)Cite this article

Subjects

Key Points

  • Cardiac imaging can complement history, electrocardiogram, and cardiac biomarkers for timely identification or ruling out of acute coronary syndrome (ACS)

  • Bedside echocardiography is the first-line imaging test in patients with suspected ACS

  • Advanced imaging techniques (stress echocardiography, computed tomography coronary angiography, myocardial perfusion scintigraphy, and cardiovascular magnetic resonance) add diagnostic and prognostic value in patients with suspected ACS

  • Novel radionuclides, such as β-methyl-p-[123I] iodophenylpentadecanoic acid, enable imaging of metabolic disturbances in glucose metabolism that result from myocardial ischaemia (which can last >12 h), thereby allowing late detection of ischaemia

  • Multiparametric tissue characterization on cardiovascular magnetic resonance enables the detection and quantification of myocardial infarction and oedema in ischaemic injury, which can be detected early after an ischaemic insult

Abstract

Noninvasive cardiac imaging has an important role in the assessment of patients with acute-onset chest pain. In patients with suspected acute coronary syndrome (ACS), cardiac imaging offers incremental value over routine clinical assessment, the electrocardiogram, and blood biomarkers of myocardial injury, to confirm or refute the diagnosis of coronary artery disease and to assess future cardiovascular risk. This Review covers the current guidelines and clinical use of the common noninvasive imaging techniques, including echocardiography and stress echocardiography, computed tomography coronary angiography, myocardial perfusion scintigraphy, positron emission tomography, and cardiovascular magnetic resonance imaging, in patients with suspected ACS, and provides an update on the developments in noninvasive imaging techniques in the past 5 years.

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Figure 1: Algorithm for the management of patients with suspected acute coronary syndrome (ACS).
Figure 2: Transthoracic echocardiography in a patient with suspected acute coronary syndrome.
Figure 3: Timeline of pathophysiological changes in ischaemic myocardium and imaging techniques used to study the associated changes.
Figure 4: Imaging in patients with suspected acute coronary syndrome.
Figure 5: Multiparametric cardiovascular magnetic resonance imaging in a patient with suspected acute coronary syndrome.

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Authors and Affiliations

  1. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK

    Pankaj Garg, John P. Greenwood & Sven Plein

  2. Imperial College London, South Kensington Campus, London, SW7 2AZ, UK

    S. Richard Underwood

  3. Royal Brompton & Harefield NHS Trust, Sydney Street, London, SW3 6NP, UK

    S. Richard Underwood

  4. Royal Brompton Hospital and Cardiovascular Biomedical Unit, National Heart and Lung Institute, Imperial College London, Sydney Street, London, SW3 6NP, UK

    Roxy Senior

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  1. Pankaj Garg
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  2. S. Richard Underwood
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  3. Roxy Senior
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  4. John P. Greenwood
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  5. Sven Plein
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Contributions

P.G. researched data for the article and wrote the manuscript. P.G., S.R.U., R.S., J.P.G., and S.P. reviewed and edited the manuscript before submission. P.G. and S.P. provided substantial contribution to the discussion of content.

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Correspondence to Sven Plein.

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The authors declare no competing financial interests.

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Garg, P., Underwood, S., Senior, R. et al. Noninvasive cardiac imaging in suspected acute coronary syndrome. Nat Rev Cardiol 13, 266–275 (2016). https://doi.org/10.1038/nrcardio.2016.18

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