You may recall a time when cardiac stress testing or a “treadmill test” was included as part of your annual physical. This test, which uses an electrocardiogram (EKG) to measure the heart’s electrical activity during exercise, helps diagnose coronary artery disease and other heart-related conditions.

Today, cardiac stress testing is no longer routine. The U.S. Preventive Services Task Force now advises doctors to use discretion, reserving this test for high-risk patients who have symptoms of heart disease or who have a confirmed heart disease diagnosis.

This shift away from annual stress testing is one of many changes in the field of cardiac imaging that aims to ensure we’re offering the right test, to the right patient, at the right time. The goal: to improve diagnostic accuracy, limit unnecessary invasive procedures, minimize cost and ensure patient safety.

The good news is that achieving this goal is more possible than ever before, thanks to the continuing advances in cardiac imaging technology. Below are some of the tests your doctor may utilize to get a better, closer look at your heart.


A PET scan provides detailed, three-dimensional images of the heart. One of the most accurate tools for diagnosing coronary artery disease, it identifies areas of decreased blood flow, which is often caused by the narrowing of coronary arteries. The test is non-invasive and uses medications rather than exercise to “stress” the heart. A PET scan may be ordered if you are experiencing symptoms of heart disease or if you’ve recently been treated for a heart condition.


Cardiac MRI uses high-powered magnets and radio waves to produce images of the beating heart and surrounding soft tissues. These images can be used to diagnose a variety of heart conditions, including coronary artery disease, heart failure and congenital heart disease. By helping doctors identify the underlying abnormalities that cause these conditions, non-invasive cardiac MRI allows doctors to pinpoint the best treatment. Although some patients — those with implanted devices like pacemakers, for example — were not eligible to undergo cardiac MRI in the past, there are now protocols in place at UVa Health that make this possible with careful monitoring.


A major advance in our ability to diagnose early coronary artery disease, computed tomography angiography (CTA) uses contrast dye and X-ray to create 3-D images that can reveal signs of plaque buildup in the arteries that feed the heart. This non-invasive scan can be combined with other tests that measure blood pressure in the heart arteries (fractional flow reserve) and the presence of calcium deposits in the arteries (calcium scoring). Measuring fractional flow reserve allows doctors to determine the severity of a blocked artery and the appropriate treatment required. Calcium scoring, which does not require the injection of contrast dye, helps predict a patient’s risk of developing coronary artery disease in the future and guides decisions about prescribing preventive treatments like medication.


Echocardiography, also known as echo or heart ultrasound, uses high-frequency sound waves to capture images of your heart in motion. There are different types of echo used to diagnose a variety of heart problems. And as we move toward less invasive, percutaneous (incision-free) surgical approaches, physicians are also using these tests more often in the treatment of valve disease. Echocardiograms are one of the most effective tests for evaluating how the heart and valves are functioning. Since they use no radiation, they can be performed as often as needed. They also can be combined with exercise- or medication-induced stress testing to provide a more comprehensive look at the heart.

Experts and visionaries

UVa Health is one of the only hospitals in Virginia to offer all of the latest advanced cardiac imaging tests. However, it’s not enough to have the right test. You need the right people to interpret the results. At UVa, cardiologists and radiologists work together to determine the appropriate tests and evaluate the results. Their expertise extends beyond the clinical setting; these providers are active in research to develop new ways of using these advanced imaging technologies that will impact the way we diagnose and treat heart disease in the future.

Learn more about heart imaging at UVa at

Vital Signs This column, which promotes community health, is sponsored by University of Virginia Health System, Sentara Martha Jefferson Hospital, Region Ten Community Services Board and Thomas Jefferson Health District. Vital Signs This column, which promotes community health, is sponsored by University of Virginia Health System, Sentara Martha Jefferson Hospital, Region Ten Community Services Board and Thomas Jefferson Health District.

Dr. Christopher Kramer is chief of the cardiovascular division and director of the Cardiovascular Imaging Center at the University of Virginia Health System.

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