Chronic Chest Pain-High Probability of CAD SPECT and CCTA Hybrid SPECT/CCTA combines the anatomical information provided by CCTA with the functional perfusion evidence of SPECT, resulting in enhanced diagnostic accuracy for detecting significant CAD compared with SPECT and CCTA alone: the sensitivity and specificity of hybrid SPECT/CCTA were 96% and 95%, respectively, compared with SPECT (93% and 79%) and CCTA (98% and 62%) alone [68]. There was 92% agreement on the necessity of revascularization in the treatment decisions based on hybrid SPECT/CCTA versus SPECT and coronary angiography alone [69]. US Echocardiography Transesophageal Ultrasound (US) echocardiography transesophageal provides assessment of LVEF and ESVI and structural assessment of the heart and ascending aorta. There is no relevant literature to support the use of transesophageal echocardiography in the initial evaluation of patients with chronic chest pain and a high probability of CAD with no known IHD. US Echocardiography Transthoracic Resting US echocardiography transthoracic resting provides assessment of ejection fraction and ventricular volumes such as LVEF and ESVI with a higher sensitivity to detect prior myocardial infarct than ischemia. Although there is no relevant literature to support transthoracic echocardiography resting in the initial evaluation of patients with chronic chest pain and a high probability of CAD with no known IHD, this modality could be used to assess new wall motion abnormalities that might raise a concern for IHD. In a meta-analysis of 435 patients (299 with and 136 without angiographically assessed CAD), dobutamine stress contractility echocardiography had 84% accuracy, 86% specificity, and 86% sensitivity for detecting CAD [71].
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. Chronic Chest Pain-High Probability of CAD SPECT and CCTA Hybrid SPECT/CCTA combines the anatomical information provided by CCTA with the functional perfusion evidence of SPECT, resulting in enhanced diagnostic accuracy for detecting significant CAD compared with SPECT and CCTA alone: the sensitivity and specificity of hybrid SPECT/CCTA were 96% and 95%, respectively, compared with SPECT (93% and 79%) and CCTA (98% and 62%) alone [68]. There was 92% agreement on the necessity of revascularization in the treatment decisions based on hybrid SPECT/CCTA versus SPECT and coronary angiography alone [69]. US Echocardiography Transesophageal Ultrasound (US) echocardiography transesophageal provides assessment of LVEF and ESVI and structural assessment of the heart and ascending aorta. There is no relevant literature to support the use of transesophageal echocardiography in the initial evaluation of patients with chronic chest pain and a high probability of CAD with no known IHD. US Echocardiography Transthoracic Resting US echocardiography transthoracic resting provides assessment of ejection fraction and ventricular volumes such as LVEF and ESVI with a higher sensitivity to detect prior myocardial infarct than ischemia. Although there is no relevant literature to support transthoracic echocardiography resting in the initial evaluation of patients with chronic chest pain and a high probability of CAD with no known IHD, this modality could be used to assess new wall motion abnormalities that might raise a concern for IHD. In a meta-analysis of 435 patients (299 with and 136 without angiographically assessed CAD), dobutamine stress contractility echocardiography had 84% accuracy, 86% specificity, and 86% sensitivity for detecting CAD [71].