Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Chronic Chest Pain-High Probability of CAD demonstration of abnormalities (eg, congenital or acquired coronary artery anomalies) as well as other etiologies for CAD that can produce chest pain in the absence of coronary obstructive disease. In patients with known IHD, imaging findings are important in determining the management of patients with chronic myocardial ischemia and can serve as a decision-making tool for medical therapy, angioplasty, stenting, or surgery. Imaging can help understand long-term prognosis and expected benefit from various therapeutic options by evaluating disease location, plaque characteristics, and pre-existing myocardial infarction, as well as determining ventricular function, diastolic relaxation, and end-systolic volume [7]. OR Discussion of Procedures by Variant Variant 1: Chronic chest pain; high probability of coronary artery disease. No known ischemic heart disease. Initial imaging. Arteriography Coronary Catheter-based selective coronary angiography is historically considered the coronary imaging modality of choice with the highest spatial and temporal resolution. Although only 2-D projection images are obtained (as opposed to 3-D volumes in coronary CTA [CCTA]), selective coronary angiography is considered to be the reference standard for depicting the anatomy and the severity of obstructive CAD and other coronary abnormalities (eg, congenital variants, coronary spasm, dissection, vasculitis) [8]. In addition to visualizing the coronary arteries, the procedure is used to guide percutaneous coronary interventions to the site of the blockage. Hemodynamic relevance of coronary stenosis identified on invasive coronary angiography (ICA) is assessed by measuring fractional flow reserve (FFR) [9,10].
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Chronic Chest Pain-High Probability of CAD demonstration of abnormalities (eg, congenital or acquired coronary artery anomalies) as well as other etiologies for CAD that can produce chest pain in the absence of coronary obstructive disease. In patients with known IHD, imaging findings are important in determining the management of patients with chronic myocardial ischemia and can serve as a decision-making tool for medical therapy, angioplasty, stenting, or surgery. Imaging can help understand long-term prognosis and expected benefit from various therapeutic options by evaluating disease location, plaque characteristics, and pre-existing myocardial infarction, as well as determining ventricular function, diastolic relaxation, and end-systolic volume [7]. OR Discussion of Procedures by Variant Variant 1: Chronic chest pain; high probability of coronary artery disease. No known ischemic heart disease. Initial imaging. Arteriography Coronary Catheter-based selective coronary angiography is historically considered the coronary imaging modality of choice with the highest spatial and temporal resolution. Although only 2-D projection images are obtained (as opposed to 3-D volumes in coronary CTA [CCTA]), selective coronary angiography is considered to be the reference standard for depicting the anatomy and the severity of obstructive CAD and other coronary abnormalities (eg, congenital variants, coronary spasm, dissection, vasculitis) [8]. In addition to visualizing the coronary arteries, the procedure is used to guide percutaneous coronary interventions to the site of the blockage. Hemodynamic relevance of coronary stenosis identified on invasive coronary angiography (ICA) is assessed by measuring fractional flow reserve (FFR) [9,10].