ESR Essentials: imaging in stable chest pain - practice recommendations by ESCR.

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Medicine

Background:

• Stable chest pain is a frequent symptom with diverse etiologies.
• Non-invasive imaging is crucial for diagnosing coronary artery disease (CAD), assessing plaque, and evaluating cardiac function.
• Computed tomography (CT) offers anatomical insights into CAD, including stenosis and plaque burden, with functional data from CT-FFR or perfusion imaging.

Purpose of the Study:

• To provide practice recommendations for selecting non-invasive imaging tests in patients with stable chest pain.
• To guide the performance and reporting of diagnostic imaging procedures.
• To optimize the diagnostic pathway for stable chest pain evaluations.

Main Methods:

• Review of non-invasive imaging modalities for stable chest pain.
• Evaluation of Coronary CT angiography (CCTA) as a first-line diagnostic tool.
• Assessment of functional imaging techniques such as Stress MRI, SPECT, PET, and echocardiography.

Main Results:

• CCTA is recommended as a first-line test for patients with low to intermediate pre-test probability of CAD.
• Functional testing is indicated for patients with known CAD of uncertain clinical significance or high pre-test probability.
• Imaging selection should be guided by patient symptoms, pre-test probability, and medical history.

Conclusions:

• Non-invasive imaging plays a pivotal role in the comprehensive assessment of stable chest pain.
• The choice between anatomical (CCTA) and functional imaging depends on individual patient characteristics and clinical context.
• Evidence supports CCTA as a high-level evidence first-line test for many patients presenting with stable chest pain.