Imaging the myocardial ischemic cascade

Arthur E. Stillman, Matthijs Oudkerk, David A. Bluemke, Menko Jan de Boer, Jens Bremerich, Ernest V. Garcia, Matthias Gutberlet, Pim van der Harst, W. Gregory Hundley, Michael Jerosch-Herold, Dirkjan Kuijpers, Raymond Y. Kwong, Eike Nagel, Stamatios Lerakis, John Oshinski, Jean François Paul, Riemer H.J.A. Slart, Vinod Thourani, Rozemarijn Vliegenthart, Bernd J. Wintersperger

Research output: Contribution to journalReview articlepeer-review

35 Scopus citations


Non-invasive imaging plays a growing role in the diagnosis and management of ischemic heart disease from its earliest manifestations of endothelial dysfunction to myocardial infarction along the myocardial ischemic cascade. Experts representing the North American Society for Cardiovascular Imaging and the European Society of Cardiac Radiology have worked together to organize the role of non-invasive imaging along the framework of the ischemic cascade. The current status of non-invasive imaging for ischemic heart disease is reviewed along with the role of imaging for guiding surgical planning. The issue of cost effectiveness is also considered. Preclinical disease is primarily assessed through the coronary artery calcium score and used for risk assessment. Once the patient becomes symptomatic, other imaging tests including echocardiography, CCTA, SPECT, PET and CMR may be useful. CCTA appears to be a cost-effective gatekeeper. Post infarction CMR and PET are the preferred modalities. Imaging is increasingly used for surgical planning of patients who may require coronary artery bypass.

Original languageEnglish
Pages (from-to)1249-1263
Number of pages15
JournalInternational Journal of Cardiovascular Imaging
Issue number8
StatePublished - 1 Aug 2018
Externally publishedYes


  • Cardiac imaging
  • Coronary artery disease
  • Ischemic heart disease


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