Heart Disease UK

Constantinos Anagnostopoulos and Richard Underwood

Despite major advances in prevention and treatment of coronary atherosclerosis, coronary heart disease (CHD) remains a major cause of mortality and morbidity in the western world. Its management consumes a large proportion of national health care budgets, a significant part of which is spent in imaging technologies. Amongst them, myocardial perfusion imaging (MPI) is an established technique with important applications in the overall management of CHD, including, diagnosis, prognostication, selection for revascularisation and assessment of acute coronary syndromes.
This supplement covers the current applications of MPI and also its cost effectiveness and use in clinical practice in the UK. In the first article, Loong and Anagnostopoulos perform a systematic review of the existing literature on the diagnosis of heart disease by radionuclide MPI. The message is that MPI possesses a high overall diagnostic accuracy and remains the standard technique for assessing myocardial perfusion in the everyday clinical practice.
The assessment of myocardial viability and hibernation in patients with cardiac failure is another area where MPI also plays an important role because it can assist in the differentiation of ischaemic and non-ischaemic aetiology and it is an optimal technique for management and assessment of prognosis.
Evidence from modelling and observational studies supports the enhanced cost effectiveness associated with MPI use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPI are more cost effective than those not using the technique. Despite this and the fact that MPI is an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction, the technique is under-utilised in the UK as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiogram performed. In view of the publication of the UK National Institute of Clinical Excellence, guidance on the role of MPI in the diagnosis and management of patients with angina and myocardial infarction, we believe that the current supplement will be a valuable source of information for both providers and users of the technique.