Dr. Pons Lladó writes about the role of diagnostic imaging in coronary heart disease. He also provides information on the patients who can benefit from these techniques.
What is the value of diagnostic imaging techniques in coronary artery disease?
Non-invasive imaging techniques are so called because they are non-invasive, they do not require the introduction of probes or catheters for their application, and they are varied in cardiology. The most innovative are cardiac magnetic resonance or CMR and computed cardiotomography, using multidetector scanners. This is a long name that we generically refer to as DMD, multidetector diagnosis. Both were introduced or have been developed throughout the 2000s and the truth is that their usefulness is increasing since, in fact, and to focus on coronary artery disease, their application or usefulness is complementary, i.e., on the one hand, the DMD, the coronary artery scanner, offers us very accurate information in great detail of the coronary arteries themselves, which is where the disease is underlying and can detect the presence of obstructions in these vessels or even determine the amount of these obstructions. This is fundamental in the study of coronary artery disease, but it is not everything. This is where the value of the other technique, CMR or cardiac resonance, lies, since it is what tells us the effects that these coronary lesions may have had on the heart, on the cardiac muscle, not only that but also to anticipate the development of future lesions and to see the degree of involvement of the heart and its potential due to coronary lesions.
Which patients can benefit from these techniques?
Certainly the patient with acute coronary syndrome, i.e. an acute condition of probable coronary origin, should go to a health center to be included in the protocols for the management and treatment of these conditions and is not a candidate for these techniques. We are talking about patients whose cardiologist suspects coronary artery disease, either because of their symptoms or because of their high risk profile. In our opinion, this type of patient should undergo a DMD study to determine whether or not coronary artery disease exists and, if it does, to quantify the degree of these lesions. This is increasingly recognized by the clinical practice guidelines of scientific societies. The role of cardioresonance, which is why we say it is complementary, is to study those patients with manifest coronary artery disease, either because it has been detected in a DMD study or because they have had an infarction or are stent carriers, to determine the extent of the disease at a given time and, therefore, to establish its prognosis with complete reliability.
How will the outcome of the tests influence the patient’s treatment?
The treatment of coronary artery disease can be medical treatment, of course, and interventional treatment, either by means of percutaneous stent implantation or surgical vascularization. The role of these techniques is relevant in each of these cases. If the scanner provides us with a road map where we see that there are blockages in some of the doubts, it indicates exactly the place where we need to open the way or make a detour, and this would be the simile of percutaneous intervention or bypass. MRI is also very important because perhaps a patient who has had an obstruction in a vessel is not worth opening a way through it because the muscle tissue dependent on that pathway is a scar, because he has suffered an infarction, and in this case intervention is not necessary. In other cases, when the cardiac muscle is deficient, as demonstrated by the MRI study, this is when the intervention is of interest. In any case, I would like to point out that the decision in this regard is up to the clinical cardiologist who has all the data, including the results of the DMD and the MRI, to decide whether or not to make a surgical indication.