Efficacy of noninvasive cardiac imaging tests in diagnosis and management of stable coronary artery disease

Abstract

The aim of this review was to discuss the current literature regarding the utility of noninvasive imaging in diagnosis and management of stable coronary artery disease (CAD) including recent data from large randomized trials assessing diagnosis and prognosis. Current guidelines recommend revascularization in patients with refractory angina and in those with potential prognostic benefit. Appropriate risk stratification through noninvasive assessment is important in ensuring patients are not exposed to unnecessary invasive coronary angiograms. The past 20 years have seen an unprecedented expansion in noninvasive imaging modalities for the assessment of stable CAD, with cardiovascular magnetic resonance and computed tomography complementing established techniques such as myocardial perfusion imaging, echocardiography and exercise electrocardiogram. In this review, we examine the current state-of-the-art in noninvasive imaging to provide an up-to-date analysis of current investigation and management options.

Keywords: CT coronary angiography; SPECT; angina; cardiovascular magnetic resonance; noninvasive imaging; stress echo.

Figure 1

Proposed investigation algorithm for patients with suspected angina focusing on patients with low or high PTP of CAD. Abbreviations: CAD, coronary artery disease; CTCA, computed tomography coronary angiography; ECG, echocardiography; ICA, invasive coronary angiography; PTP, pretest probability.

Figure 2

Proposed investigation algorithm for patients with suspected angina and intermediate probability of CAD in an “ideal” hospital with all modalities available. Abbreviations: CAD, coronary artery disease; CTCA, computed tomography coronary angiography; CTFFR, computed tomography fractional flow reserve; CMR, cardiovascular magnetic resonance; ECG, electrocardiogram; exECG, exercise ECG; SPECT, single-photon emission computed tomography.