The inclusion or exclusion of coronary artery disease is important for patient management, both from a diagnostic and prognostic view, as well as from a therapeutic view. Various detection techniques are available, including invasive (coronary angiography) or non-invasive imaging techniques. The techniques can also be divided into anatomical imaging or functional imaging, where anatomical imaging detects coronary atherosclerosis and stenosis (invasive coronary angiography, but also non-invasive coronary angiography—performed with multidetector computed tomography), while functional imaging (nuclear imaging, stress echocardiography, and cardiovascular magnetic resonance) detects ischaemia: the haemodynamic consequences of the atherosclerosis/stenosis. The early phase of atherosclerotic coronary artery disease is often asymptomatic (and anatomical imaging can be used to detect/exclude coronary atherosclerosis), whereas with progression of atherosclerotic disease, symptoms occur related to myocardial ischaemia. Non-invasive imaging can facilitate in the detection of both early (asymptomatic) and more advanced (symptomatic, ischaemic) coronary artery disease. The pathophysiological cascade of cardiac abnormalities that occur once ischaemia is induced is referred to as the ischaemic cascade. The ischaemic cascade consists of chronological development of perfusion abnormalities, followed by diastolic dysfunction, then systolic dysfunction, and finally electrocardiographic abnormalities. In this chapter, the variety of the different non-invasive imaging techniques to assess the different phases of the non-ischaemic part and the ischaemic part (ischaemic cascade) of coronary artery disease are described.
Combined functional and anatomical imaging for the detection and guiding the therapy of coronary artery disease