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Letters

Recent advances in non-invasive cardiology

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7493.732 (Published 24 March 2005) Cite this as: BMJ 2005;330:732

Authors' reply

  1. Sanjay Prasad, consultant cardiologist (S.Prasad{at}rbh.nthames.nhs.uk),
  2. Ravi Assomull, British Heart Foundation research fellow,
  3. Dudley J Pennell, director
  1. Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London SW3 6NP

EDITOR—There have been some tremendous recent advances across the spectrum of imaging modalities in cardiology, and to do justice to all of them in a limited review article is difficult. In addition, the aim of this article, as defined at the outset by the BMJ, was readability for the non-specialist reader.

Not surprisingly, we agree with Chambers et al that two exciting areas in echocardiography are the tissue Doppler assessment of myocardial contractility and stress contrast echocardiography. These have had less current clinical impact, however, certainly at the time of writing of our article. The strengths of echocardiography are evident from its heavy use and are not in great need of repetition.

Three dimensional echocardiography is also interesting and has great potential, but its current clinical role is not wide in comparison with two dimensional echocardiography, which is the clinical workhorse.

Morgan-Hughes et al raise the clinical role of coronary angiography using computed tomography. Although undoubtedly interesting, this is under evaluation, barely available in the United Kingdom, and studies indicating its value for guiding the decision to surgery are lacking. Controversy prevails over its potential future clinical role in relation to invasive coronary angiography.

Some would argue that to show established disease without showing the ischaemic burden is of little clinical value, particularly since intervention still requires an invasive approach. Aficionados who argue that computed tomography should be reserved for exclusion of coronary disease seem to treat radiation and contrast exposure as a commodity without burden. Unfortunately, widespread use in private reimbursement healthcare systems does not indicate suitability elsewhere. Prospective trials examining the balance of benefit, risk, and clinical utility are awaited with much interest.

Footnotes

  • Competing interests None declared.

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