SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

The year in cardiovascular medicine 2020: imaging

█ Current opinion

José Luis Zamorano1, Fausto J. Pinto 2 , Jorge Solano-López1, and Chiara Bucciarelli-Ducci3
1Department of Cardiology, University Hospital Ramon y Cajal, Carretera de Colmenar Km 9.100, 28034 Madrid; Spain;
2Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte (CHULN), CCUL, Universidade de Lisboa, Av. Prof. Egas Moniz MB 1649-028 Lisboa, Portugal; and
3Department of Cardiology, Bristol Heart
Institute, University Hospitals Bristol and Weston NHS Trust and University of Bristol, UK
Corresponding author. Tel: þ34 913368515; Email:


The past year has been a unique one owing to the outbreak of COVID-19, which has affected the population worldwide, with the ensuing economic and social consequences. The field of cardiology has not escaped this reality bringing with it changes in our everyday clinical praxis. The contribution of different imaging techniques to the cardiac involvement of COVID-19 with diagnostic and prognostic implications has been published very expeditiously. It is still pending to ascertain the long-term outcome of the different degrees of cardiac injury.

The recent publication of the ISCHEMIA trial (1) has resulted in a heated debate on the role of ischaemia testing in patients with stable coronary artery disease (CAD), with some colleagues advocating that ISCHEMIA has sanctioned the limited role of myocardial ischaemia in patients with stable CAD. However, this is not the conclusion of the trial, nor its primary hypothesis nor the study design and extrapolation beyond these boundaries could be incorrect. Ischaemia imaging will continue to play a major role in the diagnosis and management of stable CAD as both physicians and patients still need to clarify the cause of symptoms, coronary anatomy does not infer ischaemia or explains symptoms, and chest pain can also be of non-coronary origin. Most importantly, there is no randomized trial demonstrating that an imaging approach of coronary anatomy is superior to functional testing. In fact, PROMISE (2) is the only trial that compared the two strategies and it did not demonstrate any difference in outcome between the two approaches.



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