Excerpt

There are many reasons why Mexico-city does not look like Beverly-Hills and it has nothing to do with the excellent, colorful, spicy food south of the border! As cardiac imagers, this is the first thing that comes to our mind when we read the paper of Antonio-Villa et al1 who investigated patients referred for myocardial perfusion imaging single-photon emission computed tomography (MPI-SPECT), at a reference center for nuclear cardiology in Mexico-city. They described an abnormality rate of 66.5%! A tremendous contrast compared to the 8.7% that has been described by investigators from Cedars Sinai in Los Angeles.2 In addition, at Cedars, they observed a progressive decrease in the abnormality rate from the 41% it was in early 1990s. This decline was such that these authors suggest considerations of more cost-effective strategies for the initial work up of these low probability patients than MPI-SPECT. All of these bring us the opportunity to discuss relevant issues such as: (1) the current opportunities for multimodality and integration, (2) the always important concept of patient centered imaging and the relevance of pre-test probability estimates, (3) the recent advances in computed coronary angio-tomography (CCTA), with its advantages to exclude coronary heart disease (CHD), to diagnose initial non-obstructive disease and to guide prevention3,4 and finally, (4) the persistent underutilization of MPI-SPECT in low to mid-income countries (LMICs) where CHD mortality remains excessively high. …