Several studies have validated stress CT myocardial perfusion against SPECT, stress CMR, and invasive FFR in patients with suspected or known CAD (no clinical data reported on presence or absence of chronic chest pain) and was shown when combined with CTA to accurately predict perfusion abnormalities related to atherosclerotic luminal narrowing [19-23]. Patients with suspected or known CAD were evaluated with MPI using cardiac CT either in a single-phase mode for qualitative identification of ischemic myocardium [22] or in a multiphase mode for quantitative assessment of the myocardial blood flow [80]. Chronic infarction can often be differentiated from acute hypoperfusion by myocardial wall thinning or lower attenuation values (low or negative HU) as a result of fat tissue within the scar and/or calcifications [81]. CTA Chest CTA chest has been shown to be effective in excluding noncardiac causes for chronic chest pain narrowing the differential diagnosis and facilitating the appropriate triage for ICA. It has also been shown in some studies to facilitate the diagnosis of acute coronary syndrome and the decision on emergent catheterization, providing information on the ischemic myocardial area by detection of a localized decrease in LV enhancement [24]. There is no relevant literature to support the use of CTA chest in the initial evaluation of patients with chronic chest pain and a high probability of CAD with known IHD. CTA Triple Rule Out There is no relevant literature to support the use of TRO in the initial evaluation of patients with chronic chest pain and a high probability of CAD with known IHD. Chronic Chest Pain-High Probability of CAD thresholds of 50% [25]. In the CORE-64 study, the ROC area for cardiac CT was 0.93 using quantitative coronary angiography as the reference standard.
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. Several studies have validated stress CT myocardial perfusion against SPECT, stress CMR, and invasive FFR in patients with suspected or known CAD (no clinical data reported on presence or absence of chronic chest pain) and was shown when combined with CTA to accurately predict perfusion abnormalities related to atherosclerotic luminal narrowing [19-23]. Patients with suspected or known CAD were evaluated with MPI using cardiac CT either in a single-phase mode for qualitative identification of ischemic myocardium [22] or in a multiphase mode for quantitative assessment of the myocardial blood flow [80]. Chronic infarction can often be differentiated from acute hypoperfusion by myocardial wall thinning or lower attenuation values (low or negative HU) as a result of fat tissue within the scar and/or calcifications [81]. CTA Chest CTA chest has been shown to be effective in excluding noncardiac causes for chronic chest pain narrowing the differential diagnosis and facilitating the appropriate triage for ICA. It has also been shown in some studies to facilitate the diagnosis of acute coronary syndrome and the decision on emergent catheterization, providing information on the ischemic myocardial area by detection of a localized decrease in LV enhancement [24]. There is no relevant literature to support the use of CTA chest in the initial evaluation of patients with chronic chest pain and a high probability of CAD with known IHD. CTA Triple Rule Out There is no relevant literature to support the use of TRO in the initial evaluation of patients with chronic chest pain and a high probability of CAD with known IHD. Chronic Chest Pain-High Probability of CAD thresholds of 50% [25]. In the CORE-64 study, the ROC area for cardiac CT was 0.93 using quantitative coronary angiography as the reference standard.