Abstract
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.
Highlights
Coronary atherosclerosis is a dynamic multifocal process characterized by plaque accumulation and subsequent functional changes of coronary circulation
Physicians involved in the investigation of new onset chest pain act with the goal of preventing future major acute cardiac events (MACE) such as death or myocardial infarction, and the first step is estimating the pre-test likelihood of obstructive Coronary artery disease (CAD) according to age, gender, chest pain characteristics and prevalence of the disease in the studied population
The novelty introduced by the 2019 European Society of Cardiology (ESC) Guidelines on Chronic Coronary Syndromes in terms of CAD detection was to assign the same level of recommendation to non-invasive diagnostic techniques
Summary
Coronary atherosclerosis is a dynamic multifocal process characterized by plaque accumulation and subsequent functional changes of coronary circulation. Physicians involved in the investigation of new onset chest pain act with the goal of preventing future major acute cardiac events (MACE) such as death or myocardial infarction, and the first step is estimating the pre-test likelihood of obstructive CAD according to age, gender, chest pain characteristics and prevalence of the disease in the studied population. This stage does not require further investigations when the pre-test probability is very low The scientific evidence behind such recommendation updates and continuous technical development has led to changes in approaching the clinical setting of suspected ischaemic heart disease, and this review will summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for an up-to-date clinical management will be proposed
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