ABC | Volume 114, Nº2, February 2020

Update Update of the Brazilian Guideline on Nuclear Cardiology – 2020 Arq Bras Cardiol. 2020; 114(2):325-429 Once the doctor has answered the 2 initial questions, “Who is the patient?” and “What is the main diagnostic hypothesis?” he or she needs to answer the third question: “ What is the most appropriate test for this patient and for the question I want to answer?” To answer this question, it is essential to know the main advantages and disadvantages of the exams, integrating the results of Bayes’ theorem and, thus, defining post-test probability. It is, moreover, necessary to identify when continuous or complementary analysis will be required in order to obtain additional information for better patient management (Figure 19). Of the techniques that have been covered, angio-CT is the most recent, showing great technological evolution, notably over the past 10 years. Data from important clinical studies have consolidated and recognized the value of this modality, as well as how to integrate it with other available tools. Before the advent of angio-CT, studies of patient anatomy presented greater difficulties, as it was mainly obtained via cardiac catheterization, with all the limitations, complications, and costs associated with invasive interventions. The development of a non-invasive, relatively simple and quick imaging technique has, in recent years, made it possible to recover the role of anatomical evaluation of the heart as a diagnostic and prognostic tool, thus integrating angio-CT into the multimodality scenario. Tests that allow for evaluation of cardiac physiology, such as ET and nuclear cardiology with MPS, have been routinely utilized for many decades, and, as they are not invasive, they have been employed for a large number of patients with suspected or known CAD. A great deal has been learned about these tools’ capabilities for diagnosis Figure 19 – The importance of integrating information about different diagnostic modalities in an era of multimodalities. Generally speaking, the diagnostic modalities most used in Brazil are: exercise testing, echocardiogram, myocardial perfusion scintigraphy, angiotomography to evaluate coronary anatomy and calcium score, cardiac magnetic resonance, and, finally, invasive coronary cineangiography (cardiac catheterization). In this scenario, the doctor is central to establishing the best strategy and should ask the following questions: (1) What is my patient’s clinical profile? (2) What information am I looking for regarding the clinical hypotheses I have raised? (3) What test will provide this information? (4) Will I need further information to make a decision and manage this patient? Source: Vitola JV. 234 362