A decision aid for the right ischemia test

Berlin - International guidelines recommend that non-invasive examination be carried out in patients with suspected myocardial ischemia before decision is made about revascularization.

Which of the available methods is most suitable for which patients and which clinical pictures and when an invasive test is indicated is shown in consensus document published by the Quantitative Cardiac Imaging Study Group in Nature Reviews Cardiology ().

At the heart of the publication is one in which the procedures are on scale from 1 to 9 are rated. Methods with score of 1 to 3 are considered unsuitable for certain indications or patient groups (age, gender, BMI, etc.). With score of 4 to 6, the suitability of the respective procedure is unclear. The procedure is recommended from point value of 7.

The table is the result of systematic, multi-stage evaluation procedure, with which the scientists working with radiologist Marc Dewey from Charité-Universitätsmedizin Berlin assess the advantages and disadvantages of the different Discussed techniques. It is irrelevant whether the technology is reimbursable. (This aspect was, however, the subject of recently published article in.)

For some forms of disease it is clear that one method is superior to all others, while for others several methods come into question If heart failure is present, according to the consensus paper, for example, benefit most from magnetic resonance imaging (MRI). In addition to blood flow measurement, it also enables an assessment of the heart function and the detection of fibrosis.

Invasive flow measurements, on the other hand, are very suitable for patients with known coronary artery disease (CHD) or high probability of CHD. According to the interdisciplinary team of authors, emission tomography (PET) enables absolute quantification to be the most precise and is therefore particularly suitable for patients with CHD of multiple vessels.

Scintigraphy is the most widely available method, thanks to new technologies Quantification is now also possible.

According to the consensus document, echocardiography is the method of choice if doctors want to the blood flow in the heart of bedridden patients, since the examination can be carried out at the bedside.

Computed tomography (CT) can also be used to measure blood flow and is the only method that enables constrictions and deposits on the coronary arteries to be ed simultaneously.

Patients should also have access

"Our consensus document helps to select the best possible diagnostic strategy and could therefore help to develop individualized proposals for subsequent therapy," said Dewey in press release of the German Center for Cardiovascular Research (DZHK).

The Berlin radiologist also considers it important that patients also have access to this table in order to enable them to bring in their own wishes and ideas.

Dewey expects the recommendations to remain in effect for 4 to 5 years before they have to be revised in view of the constantly advancing technologies.