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Published on: August 9, 2024
Optimal non-invasive imaging test selection for the diagnosis of ischaemic heart disease
Christopher B Fordyce1, Pamela S Douglas1
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
Diagnosing ischemic heart disease (IHD) in stable chest pain patients is challenging. An anatomical approach using coronary computed tomography angiography (CCTA) is a viable alternative to functional testing for intermediate-risk individuals.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Angina prevalence is high and increases with age.
- Current diagnostic guidelines for angina lack consensus, with differing US and European recommendations.
- Optimal diagnostic strategies for intermediate-risk patients with stable chest pain remain debated.
Purpose of the Study:
- To evaluate the role of coronary computed tomography angiography (CCTA) in diagnosing ischemic heart disease (IHD).
- To compare anatomical versus functional testing strategies for stable chest pain.
- To inform integrated decision-making models for IHD diagnosis.
Main Methods:
- Review of recent trials, including PROMISE and SCOT-HEART.
- Analysis of anatomical strategies (e.g., CCTA) versus functional strategies.
- Consideration of patient risk stratification for intermediate-risk individuals.
Main Results:
- The PROMISE and SCOT-HEART trials support CCTA as a reasonable initial approach.
- Anatomical strategies are effective for diagnosing IHD in intermediate-risk patients.
- Evidence suggests CCTA can be an alternative to traditional functional tests.
Conclusions:
- Anatomical assessment using CCTA is a valid initial diagnostic strategy for stable chest pain.
- Integrated decision-making models incorporating both functional and anatomical approaches are recommended.
- Future diagnostic strategies should consider the benefits of CCTA in intermediate-risk populations.
Abstract:
The prevalence of angina is high in the general population, and increases with age in both sexes. Little consensus exists about which test is preferable when one is required for diagnosis, including significant differences in the current US and European guidelines. However, the recent PROMISE and SCOT-HEART trials incorporating the use of CCTA have demonstrated that an anatomical strategy is a reasonable alternative initial approach to use in intermediate-risk patients with stable chest for the diagnosis of IHD. Contemporary approaches should therefore consider both functional and anatomical strategies in an integrated decision-making model.
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