A renewed role for fluoroscopy in the evaluation of cardiac disease.

The advent of surgical therapy for ischemic heart disease and the prospects for modification of risk factors for coronary artery disease have made the detection of coronary artery disease in asymptomatic patients more important. Cardiac fluoroscopy is an inexpensive and relatively efficacious screening method for coronary artery disease. The combination of fluoroscopy and exercise stress testing is particularly promising. Cardiac fluoroscopy also retains a place in the diagnosis of valvular heart disease. For all of the reasons listed above, we strongly recommend that cardiac fluoroscopy be performed as part of the initial evaluation of any patient suspected of having heart disease. Furthermore, when coronary calcification is discovered incidentally by the radiologist, the patient and his physician should be alerted to its presence as it represents a significant risk factor for the subsequent development of symptomatic coronary artery disease.