Choi et al [19] identified atherosclerotic plaques in 215 of 1,000 middle-aged asymptomatic patients with 2% prevalence of plaque in the low-risk group. US Echocardiography Transthoracic Resting There is no relevant literature supporting the use of transthoracic echocardiography (TTE) resting in asymptomatic patients at low risk of CAD. US Echocardiography Transthoracic Stress There is no relevant literature supporting the use of TTE stress in asymptomatic patients at low risk of CAD. The sensitivity and specificity of the test is 72% to 83% and 84% to 95%, respectively, for identification of ischemic myocardium and has been validated only in elevated risk populations [20]. MRI Heart Function with Stress There is no relevant literature supporting the use of MRI heart function with stress in asymptomatic patients at low risk of CAD. MRI Heart Function and Morphology Weir-McCall et al [22] demonstrated an overall low utility of resting MRI via abnormal late gadolinium enhancement in asymptomatic low-risk volunteers (0.67% of whom were found to have abnormalities, including myocardial infarction), with only 0.2% of volunteers having a previously unrecognized myocardial infarction. Radiography Chest There is no relevant literature to support the use of chest radiographs to evaluate asymptomatic patients at low risk of CAD. Asymptomatic Patient at Risk for CAD Variant 2: Asymptomatic patient. Intermediate risk for coronary artery disease. Initial imaging. CT Coronary Calcium Kondos et al [24] found that any measurable coronary calcium was independently related to hard (death and myocardial infarction) and soft (revascularization procedure) events in men and women at low to intermediate pretest risk; this finding provided incremental prognostic information over conventional risk factors.
Asymptomatic Patient at Risk for Coronary Artery Disease PCAs. Choi et al [19] identified atherosclerotic plaques in 215 of 1,000 middle-aged asymptomatic patients with 2% prevalence of plaque in the low-risk group. US Echocardiography Transthoracic Resting There is no relevant literature supporting the use of transthoracic echocardiography (TTE) resting in asymptomatic patients at low risk of CAD. US Echocardiography Transthoracic Stress There is no relevant literature supporting the use of TTE stress in asymptomatic patients at low risk of CAD. The sensitivity and specificity of the test is 72% to 83% and 84% to 95%, respectively, for identification of ischemic myocardium and has been validated only in elevated risk populations [20]. MRI Heart Function with Stress There is no relevant literature supporting the use of MRI heart function with stress in asymptomatic patients at low risk of CAD. MRI Heart Function and Morphology Weir-McCall et al [22] demonstrated an overall low utility of resting MRI via abnormal late gadolinium enhancement in asymptomatic low-risk volunteers (0.67% of whom were found to have abnormalities, including myocardial infarction), with only 0.2% of volunteers having a previously unrecognized myocardial infarction. Radiography Chest There is no relevant literature to support the use of chest radiographs to evaluate asymptomatic patients at low risk of CAD. Asymptomatic Patient at Risk for CAD Variant 2: Asymptomatic patient. Intermediate risk for coronary artery disease. Initial imaging. CT Coronary Calcium Kondos et al [24] found that any measurable coronary calcium was independently related to hard (death and myocardial infarction) and soft (revascularization procedure) events in men and women at low to intermediate pretest risk; this finding provided incremental prognostic information over conventional risk factors.