JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases

Abstract

ABI ankle-brachial index ACC American College of Cardiology ACS acute coronary syndrome AHA American Heart Association APV averaged peak velocity ARH autosomal recessive hypercholesterolemia AS Agatston score ASO arteriosclerosis obliterans ATP adenosine triphosphate BMIPP β-methyl-p-iodophenyl-pentadecanoic acid BNP B-type natriuretic peptide CABG coronary artery bypass grafting CACS coronary artery calcium score CAD coronary artery disease CANM Canadian Association of Nuclear Medicine CanSCMR Canadian Society of Cardiovascular Magnetic Resonance CAR Canadian Association of Radiologists CCS Canadian Cardiovascular Society CCTA coronary CT angiography CDC Centers for Disease Control and Prevention CFR coronary flow reserve CFVR coronary flow velocity reserve CI confidence interval CKD chronic kidney disease CNCS Canadian Nuclear Cardiology Society CPAP continuous positive airway pressure CT computed tomography CTA computed tomography angiography CTDIvol computed omography dose index volume ▋ 2.2.1 Selection of the Lead System and Recording Time Appropriate ECG recording is essential for making a diagnosis of coronary heart disease. Care should be exercised with regard to selection of the electrodes, leads, paste, and lead system to obtain stable recordings during daily activities. The leads that are most likely to reflect ischemic changes are V5-like leads. In particular, lead CM5 is less affected by body movements and has a good detection rate for ischemic changes. 50 A 2-lead system is commonly used, and the AHA guidelines recommend a combination of leads that approximates leads V1 and V5. 51 For capturing ST elevation in patients with variant angina, vertical leads (II, III, and aVF) and approximations to lead V2 or V3 provide a high diagnostic rate. 52 Both circadian and diurnal (dayto-day) variations may exist in relation to the incidence and duration of myocardial ischemia and the extent of ST changes. However, it is difficult to evaluate the influence of diurnal variation based on 24-hour recording, which means that 48-hour recording is desirable for detecting myocardial ischemia and determining the response to treatment. ▋ 2.2.2 Criteria for ST-Segment Changes The diagnostic significance of persistent ST depression on Holter ECG is not high. Rather, detection and evaluation of transient ST-segment changes is more important. The criteria for ST depression are as follows: (1) horizontal or sagging depression of the ST segment by ≥0.1 mV; (2) reaching maximum ST depression after 1 min; and (3) ST depression of ≥0.1 mV lasting for ≥30-60 s compared with the baseline in a controlled state. 49,53-55 ST depression is measured at 0.08 s after the S or J point, and J-type ST depression is not judged to be ischemic ST depression. 52 When counting the number of ischemic episodes, the definition adopted is that each ischemic interval should last for at least 1 min. 56 The criterion for ST elevation is elevation of the ST segment by ≥0.1 mV lasting for ≥30-60 s in leads without Q waves. 49 In patients with chest pain ...

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