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Updated: Apr 30, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Imaging for cardiac disease: a practical guide for general practitioners
1MBBS, FRANZCR, Director of Imaging, Queensland X-Ray, St Vincent's and St Andrew's Hospitals, Toowoomba, QLD.
Insights
Diagnosing coronary artery disease (CAD) in Australia involves a pathway prioritizing non-invasive tests. Chest pain patients may need risk stratification via stress tests, followed by computed tomography coronary angiography for further evaluation.
Area of Science:
- Cardiology
- Radiology
- Diagnostic Imaging
Background:
- Cardiac disease is a leading cause of illness and death in Australia.
- Coronary artery disease (CAD) has numerous differential diagnoses.
- Various radiological investigations aid in diagnosing cardiac conditions.
Purpose of the Study:
- To present an updated diagnostic pathway for coronary artery disease (CAD).
- To emphasize the use of minimally invasive and accessible investigations.
- To guide the diagnosis of cardiac conditions.
Main Methods:
- Initial assessment of patients presenting with chest pain.
- Risk stratification for equivocal cases using stress tests (e.g., nuclear myocardial perfusion study, stress echocardiography).
- Further triaging with non-invasive computed tomography coronary angiography for low-to-intermediate risk patients.
Main Results:
- Many chest pain patients show diagnostic features of CAD requiring minimal further investigation.
- Stress testing effectively stratifies risk in equivocal cases.
- Computed tomography coronary angiography offers a low-risk, high-specificity option for outpatient evaluation.
Conclusions:
- A structured approach using non-invasive imaging improves CAD diagnosis.
- Computed tomography coronary angiography is valuable for risk-stratified patients.
- Further research is needed to establish the role of triple rule-out studies; MRI is currently limited by availability and study duration.
Background:
Cardiac disease is a major cause of morbidity and mortality in Australia. There are many differentials to the diagnosis of coronary artery disease (CAD). A wide range of radiological investigations are available to help diagnose cardiac conditions.
Objective:
This article seeks to provide an up-to-date pathway to diagnose CAD using the least invasive and most widely available investigations.
Discussion:
A significant number of patients presenting with chest pain have diagnostic features of CAD and these require little further study. The equivocal group will require risk stratification, generally through a stress-type examination such as nuclear myocardial perfusion study or stress echocardiography. After stratification, further triaging of those at low and intermediate risk will benefit from non-invasive computed tomography coronary angiography. This is a low-risk, high-specificity study performed as an outpatient procedure. The role of the triple rule out study is not yet established but may change the clinical approach in diagnosing the causes of chest pain in future. At this stage, MRI is not viable in terms of availability and duration of study.
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