The best of cardiac imaging in 2000: "The unveiled heart"

Cardiac functional imaging focuses on three variables which complement each other: coronary perfusion reserve (during stress or after maximal vasodila tion), myocardial viability (at cellular level) and ventricular contraction (endocardial motion or myocardial thickening). A combination of abnormal f indings (location, size and severity) helps to characterise the myocardium in terms of normal, ischaemic, stunned, hibernating or necrosis. This functional information is then used to validate the morphological imag es of coronary lesions as seen on angiography, to assess the significance o f a stenosis, to identify the culprit vessel in cases of multivessel diseas e, and to delineate the area at risk. "Non-invasive" techniques should no longer be considered only as screening methods with more sophisticated investigations in view, but should replace them at every step of patient management: at the time of diagnosis, with a "positive/negative" bayesian approach, before a therapeutic decision and du ring follow-up, especially when considering the prognosis of patients and r isk stratification when the quantitation of functional abnormalities are ma jor determinants.