Hybrid Cardiac Imaging for the Invasive Cardiologist

For decades Coronary Angiography (CA) has represented the gold standard for the diagnosis and management of coronary artery disease (CAD). Today, invasive cardiologists can overcome the limits of such a binary approach, based on the definition of obstructive or nonobstructive stenosis, and go deeply into the characterization of individual coronary atherosclerosis. Indeed, several auxiliary imaging techniques allow a more accurate definition of global coronary atherosclerotic burden and single plaque composition. These techniques, integrating CA “luminal” data, assure a better definition of CAD pathophysiology and detection of vulnerable lesions, resulting in improved stratification of individual cardiovascular risk. Furthermore, this hybrid invasive approach can be used to monitor the response to specific intensive pharmacotherapy aiming to reduce atherosclerosis progression. This chapter reviews the main characteristics of imaging modalities currently available to invasive cardiologists, summarizes clinical evidence supporting their use, and illustrates possible future medical implications.