“How many times must a man look up before he can really see the sky?” Rheumatic cardiovascular disease in the era of multimodality imaging

Table 1 Clinical findings, advantages and disadvantages of each technique

Noninvasive imaging techniques	Evaluation of	Advantages	Disadvantages
Rest echocardiography	Cardiac valves	Cheap	Operator dependent
	Pericardium	Widely available	Limitation due to poor acoustic window
	Ventricular function	Bedside	No tissue characterization
	Wall motion	No radiation
	Pulmonary pressure
Tissue doppler imaging	Measurement of myocardial velocities	The same as in rest echocardiography	Limited by angle-dependency
Stress echocardiography	CFR in LAD	The same as in rest echocardiography	The same as in rest echocardiography
	Myocardial ischemia
Transesophageal echocardiography	Valvular lesions	The same as in rest echocardiography	The same as in rest echocardiography
	Intracardiac masses		Semi-invasive
SPECT	Myocardial ischemia	Widely available	Radiation
	Ventricular function	Reasonable sensitive	High cost
		Not very specific	Low spatial resolution
PET	Myocardial ischemia	Very sensitive	Radiation
	Ventricular function	Very specific	High cost
			Low spatial resolution
			Not widely available
CT	Great vessels	Fast	Radiation
	Coronary arteries/grafts	Widely available	High cost
			Iodinated contrast agent
CMR	Ventricular function	Highly reproducible	Not widely available
	Inflammation	Operator independent	High Cost
	Perfusion	No radiation	Claustrophobia
	Fibrosis	Tissue characterisation	Non MRI compatible devices can not be scanned
	Heart disease acuity	High spatial resolution	Low temporal resolution
	Vascular disease acuity
	Vascular inflammation and/or stenosis

SPECT: Single-photon emission computed tomography; PET: Positron emission tomography; CMR: Cardiovascular magnetic resonance; CFR: Coronary flow reserve; CT: Computed tomography; LAD: Left anterior descending.