Noninvasive coronary artery imaging in the diagnosis and management of patients with ischemic heart disease

The inherent limitations of x-ray coronary angiography have led to the deve lopment for both noninvasive and minimally invasive techniques for imaging the coronary arteries to assist in the diagnosis and management of patients with ischemic heart disease. Significant advances in transesophageal echoc ardiography, electron beam computed tomography, and magnetic resonance imag ing now permit imaging of the proximal to mid-coronary arteries. Moreover, results of initial studies demonstrate the promise of these methods to dete ct coronary artery stenoses. In addition, each of these methods provides bi ochemical or physiologic data about the stenoses that are not obtainable th rough x-ray angiography. Quantification of coronary calcification via elect ron beam computed tomography has shown promise as a surrogate marker of cor onary atherosclerosis. Transesophageal echocardiography and magnetic resona nce imaging appear useful in: evaluating the physiologic significance of an giographically detectable coronary artery stenoses via assessment of corona ry blood flow. However, it should be noted that significant improvements in technology or acquisition parameters must occur before these techniques ca n be used on a routine clinical basis for coronary artery imaging. The rela tive merits and ultimate clinical potential of each of these techniques are discussed in this article. Curr Opin Cardiol 1999, 14:314-320 (C) 1999 Lip pincott Williams & Wilkins, Inc.