Clinical Review

Recent developments in non-invasive cardiology

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7479.1386 (Published 09 December 2004) Cite this as: BMJ 2004;329:1386
  1. Sanjay K Prasad (s.prasad@rbh.nthames.nhs.uk), consultant cardiologist1,
  2. Ravi G Assomull, British Heart Foundation research fellow1,
  3. Dudley J Pennell, director1
  1. 1 Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London SW3 6NP
  1. Correspondence to: S K Prasad
  • Accepted 15 October 2004

Introduction

Tremendous advances have been made in non-invasive cardiology, such as improved visualisation of the anatomy and function of the heart and better physiological markers of cardiac function and heart disease. These advances provide better diagnostic information and guide therapy and risk stratification. All the techniques give information over and above that derived from the clinical history and examination, but should be interpreted in the context of the clinical background. In this review, we discuss important developments in non-invasive cardiology, focusing on areas that have recently come into clinical use.

Sources and selection criteria

We searched PubMed for recent trials and systematic reviews on non-invasive cardiac imaging published between 2000 and July 2004. We also consulted recent international guidelines to develop an overview of the evidence base in non-invasive cardiology.

Cardiovascular magnetic resonance imaging

Cardiovascular magnetic resonance imaging has improved the detection of heart disease. Accurate diagnosis provides the basis of treatment options and of monitoring response to treatment. It also gives important prognostic information that can be difficult to glean from the history and examination alone. Conventional procedures such as echocardiography often produce suboptimal images due to poor echo windows with limited spatial resolution. In particular, the apex of the left ventricle is difficult to visualise, resulting in missed diagnoses such as apical hypertrophic cardiomyopathy.1 X ray angiography is invasive and associated with morbidity and mortality as well as exposure to ionising radiation. Cardiovascular magnetic resonance yields high resolution, high contrast images by mapping the radio signals absorbed and emitted by hydrogen nuclei in a powerful magnetic field. No x rays are involved. The contrast agent gadolinium is sometimes used to increase the signal. Gadolinium is safe, even in patients with severe renal failure. Scans can be oriented in any plane of the body and are not limited by acoustic windows. Because of its three dimensional nature, …

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