Chest Pain Evaluation: Diagnostic Testing

Overview

Journal CJC Open

Specialty Cardiology & Vascular Diseases

Date 2024 Jan 11

PMID 38204849

Authors

Benjamin J W Chow

Paul Galiwango

Anthony Poulin

Paolo Raggi

Gary Small

Daniel Juneau

Mustapha Kazmi

Bilal Ayach

Rob S Beanlands

Anthony J Sanfilippo

Chi-Ming Chow

D Ian Paterson

Michael Chetrit

Davinder S Jassal

Kim Connelly

Eric Larose

Helen Bishop

Malek Kass

Todd J Anderson

Haissam Haddad

John Mancini

Katie Doucet

Jean-Sebastien Daigle

Amir Ahmadi

Jonathan Leipsic

Siok Ping Lim

Andrew McRae

Annie Y Chou

Affiliations

Soon will be listed here.

Abstract

Chest pain/discomfort (CP) is a common symptom and can be a diagnostic dilemma for many clinicians. The misdiagnosis of an acute or progressive chronic cardiac etiology may carry a significant risk of morbidity and mortality. This review summarizes the different options and modalities for establishing the diagnosis and severity of coronary artery disease. An effective test selection algorithm should be individually tailored to each patient to maximize diagnostic accuracy in a timely fashion, determine short- and long-term prognosis, and permit implementation of evidence-based treatments in a cost-effective manner. Through collaboration, a decision algorithm was developed (www.chowmd.ca/cadtesting) that could be adopted widely into clinical practice.

Citing Articles

Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score.

Abazid R, Pati N, Elrayes M, Awadallah S, Ibrahim M, Alaref A Open Heart. 2024; 11(2).

PMID: 39214533 PMC: 11367375. DOI: 10.1136/openhrt-2024-002735.

Pain from Internal Organs and Headache: The Challenge of Comorbidity.

Affaitati G, Costantini R, Fiordaliso M, Giamberardino M, Tana C Diagnostics (Basel). 2024; 14(16).

PMID: 39202238 PMC: 11354044. DOI: 10.3390/diagnostics14161750.

References

Chih S, Chong A, Erthal F, deKemp R, Davies R, Stadnick E . PET Assessment of Epicardial Intimal Disease and Microvascular Dysfunction in Cardiac Allograft Vasculopathy. J Am Coll Cardiol. 2018; 71(13):1444-1456. DOI: 10.1016/j.jacc.2018.01.062. View

Reynolds H, Shaw L, Min J, Page C, Berman D, Chaitman B . Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity. Circulation. 2021; 144(13):1024-1038. PMC: 8478888. DOI: 10.1161/CIRCULATIONAHA.120.049755. View

Newby D, Adamson P, Berry C, Boon N, Dweck M, Flather M . Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018; 379(10):924-933. DOI: 10.1056/NEJMoa1805971. View

Chow B, Freeman M, Bowen J, Levin L, Hopkins R, Provost Y . Ontario multidetector computed tomographic coronary angiography study: field evaluation of diagnostic accuracy. Arch Intern Med. 2011; 171(11):1021-9. DOI: 10.1001/archinternmed.2011.74. View

Stocker T, Deseive S, Leipsic J, Hadamitzky M, Chen M, Rubinshtein R . Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI). Eur Heart J. 2018; 39(41):3715-3723. PMC: 6455904. DOI: 10.1093/eurheartj/ehy546. View

Paterson D, White J, Butler C, Connelly K, Guerra P, Hill M . 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society. Can J Cardiol. 2021; 37(6):835-847. DOI: 10.1016/j.cjca.2021.02.012. View

Toutouzas K, Karanasos A, Tousoulis D . Optical Coherence Tomography For the Detection of the Vulnerable Plaque. Eur Cardiol. 2018; 11(2):90-95. PMC: 6159442. DOI: 10.15420/ecr.2016:29:2. View

Dorbala S, Di Carli M, Beanlands R, Merhige M, Williams B, Veledar E . Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol. 2012; 61(2):176-84. PMC: 3549438. DOI: 10.1016/j.jacc.2012.09.043. View

Garber A, Solomon N . Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med. 1999; 130(9):719-28. DOI: 10.7326/0003-4819-130-9-199905040-00003. View

10.

Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A . Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989; 80(1):87-98. DOI: 10.1161/01.cir.80.1.87. View

11.

Murthy V, Bateman T, Beanlands R, Berman D, Borges-Neto S, Chareonthaitawee P . Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Cardiol. 2017; 25(1):269-297. DOI: 10.1007/s12350-017-1110-x. View

12.

Gargiulo P, Dellegrottaglie S, Bruzzese D, Savarese G, Scala O, Ruggiero D . The prognostic value of normal stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a meta-analysis. Circ Cardiovasc Imaging. 2013; 6(4):574-82. DOI: 10.1161/CIRCIMAGING.113.000035. View

13.

Henzlova M, Duvall W . Temporal changes in cardiac SPECT utilization and imaging findings: Where are we going and where have we been?. J Nucl Cardiol. 2019; 27(6):2178-2182. DOI: 10.1007/s12350-019-01687-y. View

14.

Henzlova M, Cerqueira M, Mahmarian J, Yao S . Stress protocols and tracers. J Nucl Cardiol. 2006; 13(6):e80-90. DOI: 10.1016/j.nuclcard.2006.08.011. View

15.

Desiderio M, Lundbye J, Baker W, Farrell M, Jerome S, Heller G . Current Status of Patient Radiation Exposure of Cardiac Positron Emission Tomography and Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging. Circ Cardiovasc Imaging. 2018; 11(12):e007565. DOI: 10.1161/CIRCIMAGING.118.007565. View

16.

Sun Z . Multislice CT angiography in coronary artery disease: Technical developments, radiation dose and diagnostic value. World J Cardiol. 2010; 2(10):333-43. PMC: 2998832. DOI: 10.4330/wjc.v2.i10.333. View

17.

Bateman T, Cullom S . Attenuation correction single-photon emission computed tomography myocardial perfusion imaging. Semin Nucl Med. 2005; 35(1):37-51. DOI: 10.1053/j.semnuclmed.2004.09.003. View

18.

Celeng C, Leiner T, Maurovich-Horvat P, Merkely B, de Jong P, Dankbaar J . Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease: A Meta-Analysis. JACC Cardiovasc Imaging. 2018; 12(7 Pt 2):1316-1325. DOI: 10.1016/j.jcmg.2018.07.022. View

19.

Greenwood J, Ripley D, Berry C, McCann G, Plein S, Bucciarelli-Ducci C . Effect of Care Guided by Cardiovascular Magnetic Resonance, Myocardial Perfusion Scintigraphy, or NICE Guidelines on Subsequent Unnecessary Angiography Rates: The CE-MARC 2 Randomized Clinical Trial. JAMA. 2016; 316(10):1051-60. DOI: 10.1001/jama.2016.12680. View

20.

Ziadi M, deKemp R, Williams K, Guo A, Chow B, Renaud J . Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol. 2011; 58(7):740-8. DOI: 10.1016/j.jacc.2011.01.065. View