Trends in Diagnostic Heart Testing : CT on the Rise as Some Traditional Techniques Decline

Trends in Diagnostic Heart Testing : CT on the Rise as Some Traditional Techniques Decline

Source: AHAIASA Journals-Circulation:

Cardiovascular Imaging | March 13, 2025 | | Cardiac Imaging

1. Shifting Trends in Cardiac Diagnostic Testing

• Cardiac diagnostic testing has evolved significantly over the past decade.

• Some modalities, such as CT-based techniques, have seen increased use, while traditional methods have declined.

2. Transthoracic Echocardiography (TTE) Remains the Most Common Modality

• TTE accounted for 61.5% of cardiac tests in 2011 and increased to 67.7% in 2022.

3. Decline of Traditional Functional Testing

• Single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) usage declined from 20.8% in 2011 to 12.9% in 2022.

• Other traditional modalities, including invasive coronary angiography (ICA), stress echocardiography, and exercise treadmill tests (ETT), have also declined.

4. Rise of Advanced Imaging Techniques

• Coronary CT angiography (CCTA), coronary artery calcium scoring (CACS), cardiac MRI (CMR), cardiac PET MPI, and stress CMR have increased in utilization.

• The SPECT MPI to CCTA ratio dropped from 61:1 in 2011 to 10:1 in 2022, signaling a shift toward CT-based techniques.

5. Impact of the COVID-19 Pandemic

• All cardiac testing techniques saw reduced utilization in 2019-2020.

• CCTA, CACS, CMR, stress CMR, and PET MPI rebounded and exceeded 2019 levels by 2022.

• Traditional nuclear imaging and ICA continued to decline post-pandemic.

6. Increased Role of Radiologists in Cardiac Imaging

• Cardiologists’ involvement in coronary artery calcium scoring (CACS) dropped from 65% in 2010 to 13% in 2022.

• A similar trend was observed in CCTA interpretation (63% in 2010 vs. 36% in 2022).

• Radiologists have taken on a more prominent role in cardiac imaging.

7. PET MPI vs. SPECT MPI

• PET MPI usage has risen as SPECT MPI declined, despite PET’s high costs and accessibility challenges.

• The availability of new 18F-based PET tracers (e.g., 18F-flurpiridaz) may further drive PET MPI adoption.

8. Growth of Cardiac CT

• CT-based cardiac tests have experienced some of the highest growth rates among all modalities.

• CCTA is increasingly preferred due to its ability to assess stenosis, characterize plaque, and aid in structural heart disease assessment.

• Despite ongoing debates about its optimal role, CCTA has emerged as a major alternative to functional testing.

9. Key Takeaways from the Study

• Traditional stress testing is being replaced by advanced functional imaging (PET MPI, stress CMR) due to superior accuracy, shorter study times, and lower radiation exposure.

• Despite U.S. guidelines favoring functional testing for CAD evaluation in older patients, CCTA exhibited one of the highest growth rates.

• SPECT MPI volume declined by nearly 50% between 2011 and 2022, while PET MPI saw one of the highest growth rates.

This study highlights a clear shift in cardiovascular diagnostic testing, with CT-based and advanced functional imaging gaining prominence while traditional stress testing declines.