scholarly journals Inappropriate testing for the diagnosis of coronary artery disease

2015 ◽  
Vol 9 (3) ◽  
Author(s):  
Giuseppe Di Pasquale ◽  
Gloria Vassilikì Coutsoumbas ◽  
Silvia Zagnoni
Keyword(s):  
Diagnostic Testing ◽  
Calcium Score ◽  
Clinical Suspicion ◽  
Diabetic Patients ◽  
Non Invasive ◽  
High Clinical Suspicion ◽  
Probability Testing ◽  
Artery Disease ◽  
Asymptomatic Subjects ◽  
Test Probability

In the last three decades also in our country it has been a huge growth of the use of non invasive testing for diagnosis of CAD. Therefore, appropriateness of prescription in diagnostic testing is crucial. Clinical evaluation is mandatory before a diagnostic test, including the evaluation of pre-test probability of the disease based on symptoms, age, sex and cardiovascular risk factors. The main benefit of testing is in patients with an intermediate pre-test probability. Testing for diagnosis of CAD is rarely appropriate in asymptomatic subjects, except for ECG exercise test in intermediate and high risk individuals, while stress or anatomic imaging is preferable in higher risk individuals. Coronary calcium score should not be used as screening test in asymptomatic subjects, except for excluding CAD in those with low pre-test probability. As far as diabetic patients is concerned, available evidence indicates an unfavorable risk-benefit ratio of extensive CAD screening, except in the presence of high clinical suspicion.

scholarly journals Impact of a decreasing pre-test probability on the performance of diagnostic tests for coronary artery disease

2019 ◽  
Vol 20 (11) ◽  
pp. 1198-1207 ◽  
Author(s):  
Luis Eduardo Juarez-Orozco ◽  
Antti Saraste ◽  
Davide Capodanno ◽  
Eva Prescott ◽  
Haitham Ballo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
False Positive ◽  
Diagnostic Technique ◽  
Non Invasive ◽  
Selection Tool ◽  
Post Test ◽  
Artery Disease ◽  
Post Test Probability ◽  
Test Probability

Abstract Aims To provide a pooled estimation of contemporary pre-test probabilities (PTPs) of significant coronary artery disease (CAD) across clinical patient categories, re-evaluate the utility of the application of diagnostic techniques according to such estimates, and propose a comprehensive diagnostic technique selection tool for suspected CAD. Methods and results Estimates of significant CAD prevalence across sex, age, and type of chest pain categories from three large-scale studies were pooled (n = 15 815). The updated PTPs and diagnostic performance profiles of exercise electrocardiogram, invasive coronary angiography, coronary computed tomography angiography (CCTA), positron emission tomography (PET), stress cardiac magnetic resonance (CMR), and SPECT were integrated to define the PTP ranges in which ruling-out CAD is possible with a post-test probability of <10% and <5%. These ranges were then integrated in a new colour-coded tabular diagnostic technique selection tool. The Bayesian relationship between PTP and the rate of diagnostic false positives was explored to complement the characterization of their utility. Pooled CAD prevalence was 14.9% (range = 1–52), clearly lower than that used in current clinical guidelines. Ruling-out capabilities of non-invasive imaging were good overall. The greatest ruling-out capacity (i.e. post-test probability <5%) was documented by CCTA, PET, and stress CMR. With decreasing PTP, the fraction of false positive findings rapidly increased, although a lower CAD prevalence partially cancels out such effect. Conclusion The contemporary PTP of significant CAD across symptomatic patient categories is substantially lower than currently assumed. With a low prevalence of the disease, non-invasive testing can rarely rule-in the disease and focus should shift to ruling-out obstructive CAD. The large proportion of false positive findings must be taken into account when patients with low PTP are investigated.

Future Trends in Coronary CT Angiography

2011 ◽  
pp. 360-366
Author(s):  
George D. Giannoglou ◽  
Sotirios A. Katranas
Keyword(s):  
High Speed ◽  
Coronary Ct Angiography ◽  
Multislice Ct ◽  
Calcium Score ◽  
Non Invasive ◽  
Coronary Ct ◽  
Endothelial Shear Stress ◽  
Artery Disease ◽  
Anomalous Coronary ◽  
Anomalous Coronary Arteries

Coronary computed tomography angiography (CCTA) is surrounded by the safety non-invasive methods offer and the advantages of high speed that multislice CT is associated with. While calcium score and recognition of anomalous coronary arteries are acceptable applications, CCTA reveals new fields of research on coronary artery disease, including lumen, bypass grafts, and stents patency, as well as endothelial shear stress and coronary stiffness measurements.

Echocardiography calcium score as predictive tools of severity of coronary artery disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Asmaa Ismail ◽  
Adham Abdeltawab ◽  
Alaa Roshdy
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Calcium Score ◽  
Syntax Score ◽  
Study Group ◽  
Non Invasive ◽  
Significant Difference ◽  
The Mean ◽  
Artery Disease

Abstract Background Coronary artery disease (CAD) represents a leading cause of death worldwide. Coronary angiography represents the gold standard for diagnosis and selection of the best treatment for the patients with coronary artery disease; however some efforts have been made to predict CAD severity and complexity using non-invasive methods in order to identify the patients at high risk for cardiovascular events with less risk to the patients and before doing coronary angiography. Characterization of coronaryartery calcification by computed tomography known as Coronary artery calcium score (CACS) is equivalent to the total coronary atherosclerosis load and is proven to be related to angiographically significant lesions. Echocardiographic calcium score is now validated against non-coronary calcium by computed tomography with lower cost and no irradiation safety issues for reclassification of cardiac risk. Aim and Objectives to determine the correlation of echocardiography calcium score to severity of coronary artery disease. Patients and Methods Patients coming to Ain Shams University Hospitals for elective coronary angiography were subjected to histoty taking, examination, blood samples and echocardiographic examination. The echocardiographic calcium score was correlated with syntax score of their coronary angiography films. Also syntax score was divided into three groups; low risk ≤ 18, intermediate risk 18-27 and high risk groups >27. Results The study included 45 patients; 21 of which were males representing 46.6% of the participants. The mean age of the whole group was 52.7 ± 8.18. The mean final calcium score of the whole study group was 4.95±1.29. The mean syntax score of the whole study group was 22.88±12.3. There was significant difference between the three subgroups of the syntax score regarding total calcium score (p value 0.013) and highly significant difference between the numerical values of syntax score and final calcium score. Conclusion Echocardiographic calcium score is correlated to syntax score and the severity of coronary artery disease. The low cost, availability and the radiation free nature of echocardiography make it an attractive candidate for the on-going research regarding the non-invasive tools for prediction of CAD.

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