ABC | Volume 113, Nº6, December 2019

Short Editorial Grossman Myocardial computed tomography perfusion Arq Bras Cardiol. 2019; 113(6):1102-1103 1. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: Results from the Clinical Outcomes Utilizing Revascularization and AggressiveDrug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283-91. 2. Shaw LJ, Cerqueira MD, Brooks MM, Althouse AD, Sansing VV, Beller GA, et al. Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. J Nucl Cardiol. 2012;19(4):658-69. 3. BodenWE, O’Rourke RA, Teo KK, Hartigan PM, MaronDJ, KostukWJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-16. 4. BARI 2D Study Group, Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360(24):2503-15. 5. ZellwegerMJ, MaraunM, Osterhues HH, Keller U, Müller-Brand J, Jeger R, et al. Progression to overt or silent CAD in asymptomatic patients with diabetes mellitus at high coronary risk: main findings of the prospective multicenter BARDOT trial with a pilot randomized treatment substudy. JACC Cardiovasc Imaging. 2014;7(10):1001-10. 6. Ker WS, Neves DGD, Magalhães TA, Santos AAS, Mesquita CT, Nacif MS. Myocardial perfusion by coronary computed tomography in the evaluation of myocardial ischemia: simultaneous stress protocol with SPECT. Arq Bras Cardiol. 2019; 113(6):1092-1101. 7. Adamson PD, Newby DE, Hill CL, Coles A, Douglas PS, Fordyce CB. Comparison of International Guidelines for Assessment of Suspected Stable Angina: insights from the PROMISE and SCOT-HEART. JACC Cardiovasc Imaging. 2018;11(9):1301-10. 8. George RT, Mehra VC, Chen MY, Kitagawa K, Arbab-Zadeh A, Miller JM, et al. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head to head comparison from the CORE 320 multicenter diagnostic performance study. Radiology. 2014;272(2):407-16. 9. Crea F, Camici PG, Bairey Merz CN. Coronary microvascular dysfunction: an update. Eur Heart J. 2014;35(17):1101-11. 10. Jaarsma C, Leiner T, Bekkers SC, Crijns HJ, Wildberger JE, Nagel E, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positrón emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2012;59(19):1719-28. 11. Takx RA, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, et al. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging. 2015 Jan;8(1):pii:e002666. References This is an open-access article distributed under the terms of the Creative Commons Attribution License SPECT is an excellent non-invasive method for evaluating stable CAD, predominantly in patients with intermediate risk, or even in high-risk patients to help in the planning of the therapeutic approach. In addition, it is possible to use exercise as the stress protocol in patients who have the adequate functional capacity and good clinical condition. It is well known that an exercise stress protocol is the method of choice to evaluate patients with suspected or established CAD. In conclusion, to assess the accuracy of a diagnostic method, it is critical to choose the right gold standard. The use of anatomic criteria based on the angio-CT findings does not invalidate the study of Ker et al., 6 which opens a perspective for a new non-invasive technique that can assist in the proper management of patients with stable CAD, as well as creates the perspective of new research in this area. In the future, myocardial perfusion by angio-TC may be aggregated to the existing diagnostic armamentarium for the evaluation of patients with stable CAD, always taking into account the characteristic of the patient, and especially the functional capacity and possibility of exercise . In this context, non‑invasive diagnostic methods that allow to perform exercise stress protocols should be the first choice. 1103