Cardiac Imaging: What Can the Future Learn From the Past?

Abstract

Tremendous strides in the understanding of the etiology of atherosclerosis have been greatly facilitated through the introduction of new methods of imaging of the vascular system. Innovations in imaging using ultrasound, single photon and positron emitting isotopes, x-rays and nuclear magnetic resonance have provided profound insights into the anatomic distribution and enabled the development of new treatment methods including bypass surgery and angioplasty. In addition, imaging tools have helped to identify the role of the various risk factors for the development of atherosclerosis.

Despite the profound reduction in morbidity and mortality of heart disease over the past 50 years, significant obstacles remain to achieve further reductions due to the challenges of sudden cardiac death, restenosis following angioplasty and bypass surgery, as well as heart failure. In the cardiovascular arena, new treatment methods have in many cases followed from the introduction of new tools for imaging the distribution and extent of atherosclerotic narrowing. The challenges for the future will be to identify those technologies with the most promise for increasing the specificity and sensitivity imaging the distribution and progression of atherosclerosis. A brief review of the evolution of diagnostic imaging and its role in understanding and treating heart and vascular disease can help define a roadmap for further advances.