Prof Udo Sechtem, Robert-Bosch Hospital, Stuttgart, Germany

Professor Udo Sechtem from Robert-Bosch Hospital, Germany, speaks to Cardio Debate & Radcliffe Cardiology about cardiac imaging in CAD during the ESC2016 Congress held in Rome, Italy.


Is cardiac MRI overused?
Well that’s a very difficult question to answer because cardiac MRI is used in different health systems in very different ways. It is not used often in the US, it is used in some institutions in the UK, and is used in some institutions in Germany. And in Germany it’s not even paid, so the major health insurers don’t pay for cardiac MRI, just as for cardiac CT in Germany.

Now I think the general question is imaging overused? And this may be the case, because patients with chest pain, whatever kind of chest pain they have they will receive imaging, and only five per cent of all studies are currently pathologic. Meaning that 95 out of 100 studies basically do not give any answer, apart from confirming what the doctor may have suspected right at the beginning – that the patient doesn’t have any serious disease.

Is it counterproductive to have so many options of cardiac imaging modalities?
I think it may be quite confusing for the GP who has the patient with chest pain sitting in front of him and he needs to make a choice. He has to send the patient somewhere, and he has heard many lectures about the benefits of this and that, and that would make it more difficult.

But it certainly doesn’t contribute to the overuse of imaging, I believe.

What is the right strategy for young people with suspected myocarditis? (Echo versus MRI)
The right strategy to diagnose whether they have myocarditis or not is sending them for an MRI exam. That makes most sense in patients who have some troponin and some ECG changes, but if MRI us normal you can reassure the patient that they don’t have any serious disease. And if it is abnormal then you have to care for him and forbid sports and work, etc, and then reimage him after three months.