How PET can be used in the routine management of coronary artery disease
Clinical applications of cardiac positron emission tomography (PET) have made dramatic advances over the past three years, particularly in myocardial perfusion imaging. These advances include cardiac-specific PET technology, specialized software, and profound biological insights into myocardial perfusion far beyond the traditional binary interpretation of perfusion images as normal or abnormal requiring arteriographic confirmation.
The advances in cardiac PET also interact powerfully with documentation that vigorous pharmacologic and lifestyle management stabilize plaque, partially reverse CAD, and decrease cardiac events by 90% at long-term follow-up. While not widely recognized, cardiac PET-including PET-CT, has been demonstrated to be the single most powerful non-invasive tool for the integrated tasks of identifying early coronary artery stenosis or diffuse disease, assessing severity of stenosis, objectively determining need for revascularization procedures, following progression or regression of disease, and directly evaluating endothelial function of the coronary arteries as a marker of early atherosclerosis.
The integration of diagnostic imaging with intense medical treatment as a combined subspecialty service has catapulted cardiac PET treatment programs into the same conceptual category as diagnostic therapeutic invasive cardiology.