CTA Coronary Arteries In a recent study, Di Cesare et al [33] showed utility of CCTA in asymptomatic patients at intermediate risk of stenosis detection in 112 out of 185 (60.5%) patients: 56 patients (30.2%) had mild stenosis, 49 patients (26.5%) had moderate stenosis, only 3 patients (1.6%) had severe stenosis, and in 4 patients (2.2%) evaluation could not be determined. US Echocardiography Transthoracic Resting There is no relevant literature supporting the use of TTE resting in asymptomatic patients at intermediate risk of CAD. Asymptomatic Patient at Risk for CAD US Echocardiography Transthoracic Stress The sensitivity and specificity of stress TTE is 85% and 89%, respectively, has been validated only in populations at elevated risk, and is best utilized to search for obstructive major epicardial coronary stenosis [34]. There is no relevant literature to support the use of stress TTE in asymptomatic patients at intermediate risk of CAD. MRA Coronary Arteries MRA of the coronary arteries can assess for arterial patency and pathologic wall thickening but not calcific burden, and it cannot reliably assess small distal vessels [35,36]. There is no relevant literature to support the use of MRA of the coronary arteries in asymptomatic patients at intermediate risk of CAD. MRI Heart Function and Morphology There is no relevant literature to support the use of MRI heart function and morphology to evaluate asymptomatic patients at intermediate risk of CAD. MRI Heart Function with Stress The IMPACT II study demonstrated a sensitivity of 67% and specificity of 61% for detection of ischemic heart disease, including 533 patients in the intermediate-risk population [37]. The vast majority of the patients in this study were symptomatic, with angina pectoris. The sensitivity and specificity of the test in the asymptomatic intermediate-risk population has not been validated.
Asymptomatic Patient at Risk for Coronary Artery Disease PCAs. CTA Coronary Arteries In a recent study, Di Cesare et al [33] showed utility of CCTA in asymptomatic patients at intermediate risk of stenosis detection in 112 out of 185 (60.5%) patients: 56 patients (30.2%) had mild stenosis, 49 patients (26.5%) had moderate stenosis, only 3 patients (1.6%) had severe stenosis, and in 4 patients (2.2%) evaluation could not be determined. US Echocardiography Transthoracic Resting There is no relevant literature supporting the use of TTE resting in asymptomatic patients at intermediate risk of CAD. Asymptomatic Patient at Risk for CAD US Echocardiography Transthoracic Stress The sensitivity and specificity of stress TTE is 85% and 89%, respectively, has been validated only in populations at elevated risk, and is best utilized to search for obstructive major epicardial coronary stenosis [34]. There is no relevant literature to support the use of stress TTE in asymptomatic patients at intermediate risk of CAD. MRA Coronary Arteries MRA of the coronary arteries can assess for arterial patency and pathologic wall thickening but not calcific burden, and it cannot reliably assess small distal vessels [35,36]. There is no relevant literature to support the use of MRA of the coronary arteries in asymptomatic patients at intermediate risk of CAD. MRI Heart Function and Morphology There is no relevant literature to support the use of MRI heart function and morphology to evaluate asymptomatic patients at intermediate risk of CAD. MRI Heart Function with Stress The IMPACT II study demonstrated a sensitivity of 67% and specificity of 61% for detection of ischemic heart disease, including 533 patients in the intermediate-risk population [37]. The vast majority of the patients in this study were symptomatic, with angina pectoris. The sensitivity and specificity of the test in the asymptomatic intermediate-risk population has not been validated.