The Non-Invasive Diagnosis of Chronic Coronary Syndrome: A Focus on Stress Computed Tomography Perfusion and Stress Cardiac Magnetic Resonance

Coronary artery disease is still a major cause of death and morbidity worldwide. In the setting of chronic coronary disease, demonstration of inducible ischemia is mandatory to address treatment. Consequently, scientific and technological efforts were made in response to the request for non-invasive diagnostic tools with better sensitivity and specificity. To date, clinicians have at their disposal a wide range of stress-imaging techniques. Among others, stress cardiac magnetic resonance (S-CMR) and computed tomography perfusion (CTP) techniques both demonstrated their diagnostic efficacy and prognostic value in clinical trials when compared to other non-invasive ischemia-assessing techniques and invasive fractional flow reserve measurement techniques. Standardized protocols for both S-CMR and CTP usually imply the administration of vasodilator agents to induce hyperemia and contrast agents to depict perfusion defects. However, both methods have their own limitations, meaning that optimizing their performance still requires a patient-tailored approach. This review focuses on the characteristics, drawbacks, and future perspectives of these two techniques.

Automated summary

Coronary artery disease remains a leading cause of death and morbidity globally. The development of non-invasive diagnostic tools with improved sensitivity and specificity has been driven by the need to detect inducible ischemia in patients with chronic coronary disease. Stress cardiac magnetic resonance (S-CMR) and computed tomography perfusion (CTP) techniques have shown diagnostic efficacy and prognostic value in clinical trials, surpassing other non-invasive ischemia-assessing techniques and invasive fractional flow reserve measurement techniques. However, both methods have limitations, requiring personalized approaches for optimal performance. This review focuses on the characteristics, drawbacks, and future perspectives of S-CMR and CTP.