Comparison of mid‐ to long‐term clinical outcomes between anatomical testing and usual care in patients with suspected coronary artery disease: A meta‐analysis of randomized trials

Hwang, In‐Chang; Choi, Sol Ji; Choi, Ji Eun; Ko, Eun-bi; Suh, Jae Kyung; Choi, In–Hwan; Kang, Hyun–Jae; Kim, Joo Youn

doi:10.1002/clc.22799

Cited by 5 publications

(3 citation statements)

References 43 publications

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“…Current strategies have focused on anatomical imaging with coronary computed tomography angiography (CCTA) with or without fractional flow reserve measurement (CCTA-FFR) and functional methods including stress ECG, stress echocardiography, and myocardial perfusion imaging (MPI) with ionizing radiation along with emergence of hybrid imaging of positron emission tomography (PET) together with CT (cardiac PET-CT). In outcomes analysis, direct coronary imaging with CCTA has shown reduced myocardial infarction (MI) compared with functional testing but without a reduction in mortality or hospitalizations at the expense of more frequent use of invasive procedures [ 2 ▪ , 3 , 4 ▪ ]. With the growing challenge of symptomatic nonobstructive CAD (NO-CAD) in clinical practice, these modalities have limited value.…”

Section: Introductionmentioning

confidence: 99%

A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease

Chaudhry

Arena

Bhatt

et al. 2018

Current Opinion in Cardiology

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Purpose of reviewThere is growing clinical interest for the use of cardiopulmonary exercise testing (CPET) to evaluate patients with or suspected coronary artery disease (CAD). With mounting evidence, this concise review with relevant teaching cases helps to illustrate how to integrate CPET data into real world patient care.Recent findingsCPET provides a novel and purely physiological basis to identify cardiac dysfunction in symptomatic patients with both obstructive-CAD and nonobstructive-CAD (NO-CAD). In many cases, abnormal cardiac response on CPET may be the only objective evidence of potentially undertreated ischemic heart disease. When symptomatic patients have NO-CAD on coronary angiogram, they are still at increased risk for cardiovascular events. This problem appears to be more common in women than men and may warrant more aggressive risk factor modification. As the main intervention is lifestyle (diet, smoking cessation, exercise) and medical therapy (statins, angiotensin-converting enzyme inhibitors, beta-blockers), serial CPET testing enables close surveillance of cardiovascular function and is responsive to clinical status.SummaryCPET can enhance outpatient evaluation and management of CAD. Diagnostically, it can help to identify physiologically significant obstructive-CAD and NO-CAD in patients with normal routine cardiac testing. CPET may be of particular value in symptomatic women with NO-CAD. Prognostically, precise quantification of improvements in exercise capacity may help to improve long-term lifestyle and medication adherence for this chronic condition.

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Section: Introductionmentioning

confidence: 99%

A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease

Chaudhry

Arena

Bhatt

et al. 2018

Current Opinion in Cardiology

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“…CAD is a spectrum of heart disease with the highest mortality rate in the world [10]. There is little information about LV dysfunction in patients with CAD.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Physical and Mechanical Parameters of the Left Ventricle by Speckle Tracking Technique for Prediction Coronary Artery Disease Patients

Ahmadi¹,

Mokhtari‐Dizaji²,

Sadeghpour³

et al. 2022

fbt

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Purpose: The goal of the study was to identify earlier pathology of the Left Ventricle (LV) using Speckle Tracking Echocardiography (STE) without angiography results for detecting Coronary Artery Disease (CAD) patients who have need invasive coronary reperfusion. Materials and Methods: A total of seventy-five referral patients to angiography (mean age 57±9 years) with chest pain, underwent Two-Dimensional Echocardiography (2D-ECG). Conventional echocardiographic parameters were calculated for the assessment of LV function. End systole and early diastole longitudinal strain, strain rate, and velocity with 2D-STE were estimated to evaluate myocardial function. Discriminated analysis was performed to detect CAD patients from the healthy group. Results: According to the angiography results, patients were divided into CAD group (n=55) and healthy group (n=20). There was a significant decrease in longitudinal strain, strain rate, and velocity in patients with CAD compared to the healthy group (systolic longitudinal strain for CAD group -15.9±2.2% vs. -19.6±2.2% for healthy group and early diastolic longitudinal strain for CAD patients -9.5±1.2% vs. -12.0±1.3% for the healthy group) (P-value<0.05). Discriminate analysis of end-systolic and early diastolic longitudinal strain with 81.8% and 89.1% indicated the highest sensitivity, respectively. Conclusions: End systolic and early diastolic longitudinal strain parameters derived with the STE method are superior predictors for detecting CAD patients referred to angiography for revascularization.

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“…Exercise Testing in Suspected Coronary Artery Disease (CRESCENT) [ 100 ] and the Cardiac CT for the Assessment of Pain and Plaque (CAPP) [ 101 ]. A meta-analysis including most of the above studies in patients with either acute or stable chest pain showed that anatomical testing with CCTA as the initial non-invasive diagnostic modality resulted in a lower risk of non-fatal myocardial infarction, but not MACEs or all-cause mortality, as compared with the usual care with functional testing at the expense of a more frequent use of invasive procedures [ 102 ]. Moreover, a systematic review in patients with acute or stable chest pain showed that CCTA is cost-effective when compared with the standard of care, including functional testing [ 103 ].…”

Section: Contrast-enhanced Ctmentioning

confidence: 99%

Non-Contrast and Contrast-Enhanced Cardiac Computed Tomography Imaging in the Diagnostic and Prognostic Evaluation of Coronary Artery Disease

et al. 2023

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In recent decades, cardiac computed tomography (CT) has emerged as a powerful non-invasive tool for risk stratification, as well as the detection and characterization of coronary artery disease (CAD), which remains the main cause of morbidity and mortality in the world. Advances in technology have favored the increasing use of cardiac CT by allowing better performance with lower radiation doses. Coronary artery calcium, as assessed by non-contrast CT, is considered to be the best marker of subclinical atherosclerosis, and its use is recommended for the refinement of risk assessment in low-to-intermediate risk individuals. In addition, coronary CT angiography (CCTA) has become a gate-keeper to invasive coronary angiography (ICA) and revascularization in patients with acute chest pain by allowing the assessment not only of the extent of lumen stenosis, but also of its hemodynamic significance if combined with the measurement of fractional flow reserve or perfusion imaging. Moreover, CCTA provides a unique incremental value over functional testing and ICA by imaging the vessel wall, thus allowing the assessment of plaque burden, composition, and instability features, in addition to perivascular adipose tissue attenuation, which is a marker of vascular inflammation. There exists the potential to identify the non-obstructive lesions at high risk of progression to plaque rupture by combining all of these measures.

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Comparison of mid‐ to long‐term clinical outcomes between anatomical testing and usual care in patients with suspected coronary artery disease: A meta‐analysis of randomized trials

Abstract: Anatomical testing with CCTA as the initial noninvasive diagnostic modality in patients with suspected CAD resulted in lower risk of nonfatal MI than usual care with functional testing, at the expense of more frequent use of invasive procedures.

Cited by 5 publications

References 43 publications

A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease

A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease

Assessment of Physical and Mechanical Parameters of the Left Ventricle by Speckle Tracking Technique for Prediction Coronary Artery Disease Patients

Non-Contrast and Contrast-Enhanced Cardiac Computed Tomography Imaging in the Diagnostic and Prognostic Evaluation of Coronary Artery Disease

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