There are no relevant data published on the use of CT heart for assessment of heart function and regional wall motion abnormalities in patients with chronic chest pain who have a high probability for CAD. Several studies have validated stress CT myocardial perfusion against SPECT, stress cardiac MR (CMR), and invasive FFR in patients with suspected or known CAD (no clinical data reported on the presence or absence of chronic chest pain), and it was shown, when combined with CTA, to accurately predict perfusion abnormalities related to atherosclerotic luminal narrowing [19-23]. CTA Chest CTA chest has been shown to be effective in excluding noncardiac causes for chronic chest pain. It has also been shown in some studies to facilitate the diagnosis of acute coronary syndrome and the decision on emergent catheterization, when left ventricular (LV) myocardial ischemia is identified [24]. There is no relevant literature to support non-ECG-gated CTA of the chest in the evaluation of chronic chest pain for the initial evaluation of CAD in patients who are high risk and without known IHD. CTA Triple Rule Out Triple rule out (TRO) is used for diagnosis of acute chest pain and simultaneous assessment of aorta, coronary arteries, and pulmonary arteries. There is no relevant literature to support the use of TRO in patients with chronic chest pain and a high probability of CAD with no known IHD. CCTA obtained in addition to standard of care in patients with stable chest pain with a high pretest probability of CAD has been demonstrated to result in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years compared with standard of care alone [32].
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. There are no relevant data published on the use of CT heart for assessment of heart function and regional wall motion abnormalities in patients with chronic chest pain who have a high probability for CAD. Several studies have validated stress CT myocardial perfusion against SPECT, stress cardiac MR (CMR), and invasive FFR in patients with suspected or known CAD (no clinical data reported on the presence or absence of chronic chest pain), and it was shown, when combined with CTA, to accurately predict perfusion abnormalities related to atherosclerotic luminal narrowing [19-23]. CTA Chest CTA chest has been shown to be effective in excluding noncardiac causes for chronic chest pain. It has also been shown in some studies to facilitate the diagnosis of acute coronary syndrome and the decision on emergent catheterization, when left ventricular (LV) myocardial ischemia is identified [24]. There is no relevant literature to support non-ECG-gated CTA of the chest in the evaluation of chronic chest pain for the initial evaluation of CAD in patients who are high risk and without known IHD. CTA Triple Rule Out Triple rule out (TRO) is used for diagnosis of acute chest pain and simultaneous assessment of aorta, coronary arteries, and pulmonary arteries. There is no relevant literature to support the use of TRO in patients with chronic chest pain and a high probability of CAD with no known IHD. CCTA obtained in addition to standard of care in patients with stable chest pain with a high pretest probability of CAD has been demonstrated to result in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years compared with standard of care alone [32].