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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Diagnostic performance of non-invasive imaging for stable coronary artery disease: A meta-analysis
Gianluca Pontone1, Andrea I Guaricci2, Suetonia C Palmer3
1Centro Cardiologico Monzino IRCCS, Milan, Italy.
Insights
Non-invasive coronary artery disease (CAD) tests show varying diagnostic performance. Coronary CT angiography best excludes CAD, while stress CT perfusion, cardiac MRI, and PET best identify patients needing invasive evaluation.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Technology
Background:
- Coronary artery disease (CAD) diagnosis relies on invasive fractional flow reserve (FFR).
- Non-invasive diagnostic tests require performance evaluation against FFR.
Purpose of the Study:
- To assess the diagnostic performance of non-invasive tests for CAD.
- To compare non-invasive tests against invasive FFR as the gold standard.
Main Methods:
- Systematic review of 77 studies comparing non-invasive tests with invasive FFR.
- Searched Medline, Embase, and relevant citations up to March 2017.
Main Results:
- Coronary CT angiography demonstrated the highest sensitivity (88%) for detecting significant coronary lesions.
- Stress myocardial CT perfusion with coronary CT angiography, stress cardiac MRI, and PET showed the highest specificity (91%) for ruling out CAD.
Conclusions:
- Coronary CT angiography is highly effective for excluding clinically significant CAD.
- Positive stress myocardial CT perfusion, stress cardiac MRI, and PET are valuable for identifying patients requiring further invasive assessment.
Background:
To determine diagnostic performance of non-invasive tests using invasive fractional flow reserve (FFR) as reference standard for coronary artery disease (CAD).
Methods:
Medline, Embase, and citations of articles, guidelines, and reviews for studies were used to compare non-invasive tests with invasive FFR for suspected CAD published through March 2017.
Results:
Seventy-seven studies met inclusion criteria. The diagnostic test with the highest sensitivity to detect a functionally significant coronary lesion was coronary computed tomography (CT) angiography [88%(85%-90%)], followed by FFR derived from coronary CT angiography (FFRCT) [85%(81%-88%)], positron emission tomography (PET) [85%(82%-88%)], stress cardiac magnetic resonance (stress CMR) [81%(79%-84%)], stress myocardial CT perfusion combined with coronary CT angiography [79%(74%-83%)], stress myocardial CT perfusion [77%(73%-80%)], stress echocardiography (Echo) [72%(64%-78%)] and stress single-photon emission computed tomography (SPECT) [64%(60%-68%)]. Specificity to rule out CAD was highest for stress myocardial CT perfusion added to coronary CT angiography [91%(88%-93%)], stress CMR [91%(90%-93%)], and PET [87%(86%-89%)].
Conclusion:
A negative coronary CT angiography has a higher test performance than other index tests to exclude clinically-important CAD. A positive stress myocardial CT perfusion added to coronary CT angiography, stress cardiac MR, and PET have a higher test performance to identify patients requiring invasive coronary artery evaluation.
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Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...