Hybrid Cardiac Imaging for Clinical Decision-Making: From Diagnosis to Prognosis

Performing any diagnostic test in medicine is always a matter of trying  to get the condition of the patient diagnosed properly with the least  effort, exposure, discomfort and at the same time with the lowest  possible error probability.

Pre-test probability is helpful but  often imprecise, effectively overestimating the patient's risk profile.  In a broader prevention objective, the phases of a disease, its onset,  progression, and complications must be taken into account. The negative  predictive value, which is so important, has in turn its main limitation  in identifying the healthy patient, that is, the one who does not  belong to any cluster of patients in which we would act in terms of  prevention.

 In coronary syndromes, the goal is instead to  evaluate coronary heart disease, from mild to more extensive and  significant forms. For this purpose, it is necessary to use parameters  that investigate different and complementary aspects: stenosis,  ischemia, the morphology of the atherosclerotic plaque, metabolic  processes, in particular vitality and apoptosis, the presence of  inflammatory processes.

The possibility, already present thanks  to Hybrid Imaging, of 'joining’ exams that study different aspects, will  allow the patient to be increasingly characterized not only from a  diagnostic point of view but also from a prognostic and personalized  therapeutic choice.