Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
Department of Radiology, Royal Papworth Hospital, Cambridge, UK.
Eur Radiol. 2024 Oct;34(10):6559-6567. doi: 10.1007/s00330-024-10739-y. Epub 2024 Apr 16.
Stable chest pain is a common symptom with multiple potential causes. Non-invasive imaging has an important role in diagnosis and guiding management through the assessment of coronary stenoses, atherosclerotic plaque, myocardial ischaemia or infarction, and cardiac function. Computed tomography (CT) provides the anatomical evaluation of coronary artery disease (CAD) with the assessment of stenosis, plaque type and plaque burden, with additional functional information available from CT fractional flow reserve (FFR) or CT myocardial perfusion imaging. Stress magnetic resonance imaging, nuclear stress myocardial perfusion imaging, and stress echocardiography can assess myocardial ischaemia and other cardiac functional parameters. Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. Functional testing may be considered for patients with known CAD, where the clinical significance is uncertain based on anatomical testing, or in patients with high pre-test probability. This practice recommendations document can be used to guide the selection of non-invasive imaging for patients with stable chest pain and provides brief recommendations on how to perform and report these diagnostic tests. KEY POINTS: The selection of non-invasive imaging tests for patients with stable chest pain should be based on symptoms, pre-test probability, and previous history. Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability. KEY RECOMMENDATIONS: Non-invasive imaging is an important part of the assessment of patients with stable chest pain. The selection of non-invasive imaging test should be based on symptoms, pre-test probability, and previous history. (Level of evidence: High). Coronary CT angiography can be used as a first line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. CT provides information on stenoses, plaque type, plaque volume, and if required functional information with CT fractional flow reserve or CT perfusion. (Level of evidence: High). Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability. Stress MRI, SPECT, PET, and echocardiography can provide information on myocardial ischemia, along with cardiac functional and other information. (Level of evidence: Medium).
稳定型胸痛是一种常见症状,可能由多种潜在原因引起。非侵入性影像学检查在诊断和指导管理方面具有重要作用,可评估冠状动脉狭窄、动脉粥样硬化斑块、心肌缺血或梗死以及心功能。计算机断层扫描(CT)可提供冠状动脉疾病(CAD)的解剖学评估,包括狭窄、斑块类型和斑块负荷的评估,并可通过 CT 血流储备分数(FFR)或 CT 心肌灌注成像提供额外的功能信息。应激磁共振成像、核应激心肌灌注成像和应激超声心动图可评估心肌缺血和其他心功能参数。冠状动脉 CT 血管造影可用于许多稳定型胸痛患者的一线检查,特别是那些低至中度预测试概率的患者。对于已知 CAD 患者,如果基于解剖学检查,CAD 的临床意义不确定,或者对于高预测试概率的患者,可以考虑进行功能检查。本实践推荐文件可用于指导稳定型胸痛患者的非侵入性影像学选择,并提供关于如何进行和报告这些诊断性检查的简要建议。要点:选择稳定型胸痛患者的非侵入性影像学检查应基于症状、预测试概率和既往病史。对于许多稳定型胸痛患者,特别是那些低至中度预测试概率的患者,冠状动脉 CT 血管造影可作为一线检查。对于已知 CAD 患者,如果基于解剖学检查,CAD 的临床意义不确定,或者对于高预测试概率的患者,可以考虑进行功能检查。主要建议:非侵入性影像学检查是稳定型胸痛患者评估的重要组成部分。非侵入性影像学检查的选择应基于症状、预测试概率和既往病史。(证据水平:高)。对于许多稳定型胸痛患者,特别是那些低至中度预测试概率的患者,冠状动脉 CT 血管造影可作为一线检查。CT 可提供狭窄、斑块类型、斑块体积的信息,如有需要还可提供 CT 血流储备分数或 CT 灌注的功能信息。(证据水平:高)。对于已知 CAD 患者,如果基于解剖学检查,CAD 的临床意义不确定,或者对于高预测试概率的患者,可以考虑进行功能检查。应激 MRI、SPECT、PET 和超声心动图可提供心肌缺血以及心功能和其他信息。(证据水平:中)。