Cardiac CT Vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Overview

Journal Curr Cardiovasc Imaging Rep

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2015 Oct 27

PMID 26500716

Citations 9

Authors

Amir Ali Rahsepar

Armin Arbab-Zadeh

Affiliations

Soon will be listed here.

Abstract

Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many healthcare systems relied on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows to noninvasively visualize coronary artery disease, challenging the role of stress testing as the default noninvasive imaging tool for evaluating patients with chest pain. In this review, we summarize current data on the clinical utility of cardiac computed tomography and stress testing in stable patients with suspected coronary artery disease.

Citing Articles

Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging").

Bays H, Khera A, Blaha M, Budoff M, Toth P Am J Prev Cardiol. 2021; 6:100176.

PMID: 34327499 PMC: 8315431. DOI: 10.1016/j.ajpc.2021.100176.

Nourin-Dependent miR-137 and miR-106b: Novel Biomarkers for Early Diagnosis of Myocardial Ischemia in Coronary Artery Disease Patients.

Elgebaly S, Christenson R, Kandil H, Ibrahim M, Rizk H, El-Khazragy N Diagnostics (Basel). 2021; 11(4).

PMID: 33919942 PMC: 8070915. DOI: 10.3390/diagnostics11040703.

Role of cardiac nuclear stress perfusion exam after computed tomographic coronary angiogram for evaluation of obstructive coronary artery disease in patients with chest pain.

Gul M, Sheikh M, Chaudhry A, Gerges L, Al Halabi H, Feldman E J Thorac Dis. 2020; 12(9):5067-5077.

PMID: 33145083 PMC: 7578483. DOI: 10.21037/jtd-2019-pitd-12.

Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress Protocol with SPECT.

Ker W, Neves D, Magalhaes T, Dos Santos A, Mesquita C, Nacif M Arq Bras Cardiol. 2019; 113(6):1092-1101.

PMID: 31596324 PMC: 7021272. DOI: 10.5935/abc.20190201.

The Effect of Effort Test on the Levels of Ischemia Modified Albumin, 7-ketocholesterol and Cholestan-3β , 5α , 6β -triol and their Role in the Diagnosis of Coronary Artery Disease.

Keles M, Samadi A, Isikhan S, Sener Y, Sezgin A, Keles E J Med Biochem. 2019; 38(3):249-255.

PMID: 31156334 PMC: 6534955. DOI: 10.2478/jomb-2018-0028.

References

Schwitter J, Wacker C, Wilke N, Al-Saadi N, Sauer E, Huettle K . MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a.... Eur Heart J. 2012; 34(10):775-81. DOI: 10.1093/eurheartj/ehs022. View

Underwood S, Anagnostopoulos C, Cerqueira M, Ell P, Flint E, Harbinson M . Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging. 2004; 31(2):261-91. PMC: 2562441. DOI: 10.1007/s00259-003-1344-5. View

Ko B, Cameron J, Meredith I, Leung M, Antonis P, Nasis A . Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J. 2011; 33(1):67-77. DOI: 10.1093/eurheartj/ehr268. View

Shaw L, Berman D, Maron D, Mancini G, Hayes S, Hartigan P . Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008; 117(10):1283-91. DOI: 10.1161/CIRCULATIONAHA.107.743963. View

Min J, Berman D, Budoff M, Jaffer F, Leipsic J, Leon M . Rationale and design of the DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic AngiOgraphy) study. J Cardiovasc Comput Tomogr. 2011; 5(5):301-9. DOI: 10.1016/j.jcct.2011.08.003. View

Sharma A, Arbab-Zadeh A . Assessment of coronary heart disease by CT angiography: current and evolving applications. J Nucl Cardiol. 2012; 19(4):796-806. DOI: 10.1007/s12350-012-9556-3. View

Fihn S, Blankenship J, Alexander K, Bittl J, Byrne J, Fletcher B . 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice.... Circulation. 2014; 130(19):1749-67. DOI: 10.1161/CIR.0000000000000095. View

Geleijnse M, Krenning B, van Dalen B, Nemes A, Soliman O, Bosch J . Factors affecting sensitivity and specificity of diagnostic testing: dobutamine stress echocardiography. J Am Soc Echocardiogr. 2009; 22(11):1199-208. DOI: 10.1016/j.echo.2009.07.006. View

Fleischmann K, Hunink M, Kuntz K, Douglas P . Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. JAMA. 1998; 280(10):913-20. DOI: 10.1001/jama.280.10.913. View

10.

Rochitte C, George R, Chen M, Arbab-Zadeh A, Dewey M, Miller J . Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J. 2013; 35(17):1120-30. PMC: 6693293. DOI: 10.1093/eurheartj/eht488. View

11.

Maddox T, Stanislawski M, Grunwald G, Bradley S, Ho P, Tsai T . Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA. 2014; 312(17):1754-63. PMC: 4893304. DOI: 10.1001/jama.2014.14681. View

12.

Budoff M, Liu S, Chow D, Flores F, Hsieh B, Gebow D . Coronary CT angiography versus standard of care strategies to evaluate patients with potential coronary artery disease; effect on long term clinical outcomes. Atherosclerosis. 2014; 237(2):494-8. DOI: 10.1016/j.atherosclerosis.2014.09.038. View

13.

Ovrehus K, Jensen J, Mickley H, Munkholm H, Bottcher M, Botker H . Comparison of usefulness of exercise testing versus coronary computed tomographic angiography for evaluation of patients suspected of having coronary artery disease. Am J Cardiol. 2010; 105(6):773-9. DOI: 10.1016/j.amjcard.2009.11.006. View

14.

Koo B, Erglis A, Doh J, Daniels D, Jegere S, Kim H . Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained.... J Am Coll Cardiol. 2011; 58(19):1989-97. DOI: 10.1016/j.jacc.2011.06.066. View

15.

Kim C, Kwok Y, Heagerty P, Redberg R . Pharmacologic stress testing for coronary disease diagnosis: A meta-analysis. Am Heart J. 2001; 142(6):934-44. DOI: 10.1067/mhj.2001.119761. View

16.

Min J, Shaw L, Berman D, Gilmore A, Kang N . Costs and clinical outcomes in individuals without known coronary artery disease undergoing coronary computed tomographic angiography from an analysis of Medicare category III transaction codes. Am J Cardiol. 2008; 102(6):672-8. DOI: 10.1016/j.amjcard.2008.04.045. View

17.

Hlatky M, Shilane D, Hachamovitch R, DiCarli M . Economic outcomes in the Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease registry: the SPARC Study. J Am Coll Cardiol. 2014; 63(10):1002-8. DOI: 10.1016/j.jacc.2013.11.038. View

18.

Chow B, Small G, Yam Y, Chen L, McPherson R, Achenbach S . Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter.... Arterioscler Thromb Vasc Biol. 2015; 35(4):981-9. PMC: 4376658. DOI: 10.1161/ATVBAHA.114.304351. View

19.

George R, Arbab-Zadeh A, Miller J, Kitagawa K, Chang H, Bluemke D . Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging. 2009; 2(3):174-82. PMC: 3035629. DOI: 10.1161/CIRCIMAGING.108.813766. View

20.

Panza J, Holly T, Asch F, She L, Pellikka P, Velazquez E . Inducible myocardial ischemia and outcomes in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol. 2013; 61(18):1860-70. PMC: 3755503. DOI: 10.1016/j.jacc.2013.02.014. View