Abstract
ObjectivesTo assess the computed tomography coronary angiography (CTCA) accuracy for demonstrating possible non-cardiovascular causes of non-acute retrosternal chest pain in patients without known coronary artery disease (CAD) and to correlate CTCA results with the patient management and relief from pain.MethodsThis prospective observational study was approved by the ethical committee. Consecutive patients suffering non-acute chest pain who underwent CTCA and with not known CAD were enrolled and classified as having coronary diseases (CD) or extracardiac diseases (ECD). Association between age, sex, body mass index (BMI), cardiovascular risk factors, and type of chest pain with CD or ECD was estimated. Correlation between BMI classes and each risk factor was also calculated.ResultsA total of 106 patients (60 males; age 62 ± 14 years [mean ± standard deviation]; mean BMI 27) were enrolled. Hypertension was found in 71/106 (67%); smoking was significantly more frequent among males (p = 0.003) and hypercholesterolemia among females (p = 0.017); hypertension and hypercholesterolemia significantly correlated with age, and hypertension also with BMI. Pain was atypical in 70/106 (66%) patients. The kind of pain did not correlate with disease or gender. CTCA showed possible causes of chest pain in 69/106 (65%) patients; 32/69 (47%) having only CD, 23/69 (33%) only ECD, and 14/69 (20%) both CD and ECD. Prevalence was: hiatal hernia 35/106 (33%); significant CAD 24/106 (23%); myocardial bridging 22/106 (21%). At follow-up of 94/106 (89%) patients, 71/94 (76%) were pain-free, 14/17 (82%) significant CAD had been treated, and only one patient with non-significant CAD was treated after CTCA.ConclusionCTCA suggested possible causes of non-acute pain in 65% of patients.Main messages• CTCA can either rule in or rule out possible causes of chest pain alternative to CAD.• Clinically relevant findings were detected in 65% of patients with non-acute chest pain.• Non-cardiovascular diseases potentially explained symptoms in 35% of patients.
Highlights
The differential diagnosis of retrosternal chest pain can be difficult [1, 2]
All consecutive patients who arrived in the Radiology Department of our hospital, between July 2010 and September 2014, to perform a computed tomography coronary angiography (CTCA) for many clinical questions, and affected by retrosternal chest pain, were prospectively included
The distribution of hypertension and hypercholesterolemia in the study population was significantly correlated to patient age
Summary
The differential diagnosis of retrosternal chest pain can be difficult [1, 2]. Angina-like retrosternal chest pain can arise either from cardiovascular or from non-cardiovascular causes, such as hiatal hernia and esophageal disease [1,2,3]. Patient history does not have a high predictive value for the origin of chest pain [2]. Most patients with retrosternal chest pain consult a cardiologist. This often results in a late referral to other specialists, after a cardiac origin of the symptoms had been definitely excluded, with persistent patient discomfort for months after the first painful episode [2]
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