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Non-invasive assessment of the risk of coronary heart disease

Rodney C Richie1

  • 1Texas Life Insurance Company, USA.

Journal of Insurance Medicine (New York, N.Y.)
|August 12, 2004
PubMed

Insights

Non-invasive tests help assess coronary heart disease (CHD) risk, especially in those with suspected disease. A positive exercise treadmill test (ETT) or high electron beam computed tomography (EBCT) calcium score indicates increased CHD risk.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Preventive Medicine

Background:

  • Non-invasive diagnostic testing for coronary heart disease (CHD) is increasingly utilized in clinical practice and life insurance risk assessment.
  • The accuracy of diagnostic tests is influenced by pretest disease probability, test sensitivity, and specificity.

Purpose of the Study:

  • To review the diagnostic accuracy of various non-invasive tests for assessing coronary heart disease (CHD) risk.
  • To evaluate the utility of exercise treadmill testing (ETT), myocardial perfusion imaging, stress echocardiography, and electron beam computed tomography (EBCT) in CHD risk assessment.

Main Methods:

  • A comprehensive literature review was conducted using the Medline database.
  • The review focused on studies evaluating the accuracy of non-invasive cardiac diagnostic modalities.

Main Results:

  • Non-invasive testing demonstrates the highest utility in patients with known or suspected coronary heart disease (CHD).
  • Low pretest likelihood of disease can limit predictive value, particularly in younger individuals or those without established risk factors.
  • A positive exercise treadmill test (ETT) or an electron beam computed tomography (EBCT) calcium score exceeding 160 is associated with increased CHD risk.

Conclusions:

  • Non-invasive cardiac testing is a valuable tool for risk stratification in patients with suspected or confirmed coronary heart disease (CHD).
  • The interpretation of test results must consider the pretest probability of disease.
  • Elevated findings on ETT or EBCT (calcium score >160) can serve as significant indicators of CHD risk.
Abstract

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