CCTA has been shown to change treatment among 23% of patients in the CCTA arm compared with 5% in the standard-of-care arm with increased use of preventive therapy when atherosclerosis was identified and cancellations of preventive and antianginal therapy with normal coronaries [32]. CCTA and FFR-CT FFR-CT allows for determination of lesion-specific ischemia associated with a coronary arterial narrowing. FFR- CT is performed in conjunction with CCTA [33,34]. FFR-CT has a high diagnostic performance when compared against invasive FFR as the reference standard: 82% specificity and 74% PPV [33]. In a multicenter trial (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]), 5,083 patients demonstrated the prognostic value of CTA with FFR-CT in patients with stable chest pain with a trend to lower major adverse cardiac events and lower cardiovascular death or myocardial infarction with a negative FFR- CT [39]. MRA Coronary Arteries Without and With IV Contrast Coronary MR angiography (MRA) does not assess late gadolinium enhancement or viability. MRA coronary arteries can demonstrate lumen narrowing of the proximal coronary arteries. There are limited data on the use of MRA coronary arteries without and with intravenous (IV) contrast in symptomatic patients with a high probability for CAD. In a single-center prospective study in patients with suspected CAD, 82% sensitivity, 90% specificity, 88% PPV, and 86% NPV for detecting significant CAD were demonstrated [40]. MRA Coronary Arteries Without IV Contrast There is limited data on the use of MRA coronary arteries without IV contrast in symptomatic patients with a high probability for CAD.
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. CCTA has been shown to change treatment among 23% of patients in the CCTA arm compared with 5% in the standard-of-care arm with increased use of preventive therapy when atherosclerosis was identified and cancellations of preventive and antianginal therapy with normal coronaries [32]. CCTA and FFR-CT FFR-CT allows for determination of lesion-specific ischemia associated with a coronary arterial narrowing. FFR- CT is performed in conjunction with CCTA [33,34]. FFR-CT has a high diagnostic performance when compared against invasive FFR as the reference standard: 82% specificity and 74% PPV [33]. In a multicenter trial (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]), 5,083 patients demonstrated the prognostic value of CTA with FFR-CT in patients with stable chest pain with a trend to lower major adverse cardiac events and lower cardiovascular death or myocardial infarction with a negative FFR- CT [39]. MRA Coronary Arteries Without and With IV Contrast Coronary MR angiography (MRA) does not assess late gadolinium enhancement or viability. MRA coronary arteries can demonstrate lumen narrowing of the proximal coronary arteries. There are limited data on the use of MRA coronary arteries without and with intravenous (IV) contrast in symptomatic patients with a high probability for CAD. In a single-center prospective study in patients with suspected CAD, 82% sensitivity, 90% specificity, 88% PPV, and 86% NPV for detecting significant CAD were demonstrated [40]. MRA Coronary Arteries Without IV Contrast There is limited data on the use of MRA coronary arteries without IV contrast in symptomatic patients with a high probability for CAD.