Abstract
The cardiac stress testing, carotid duplex, coronary artery calcium (CAC) scoring, myocardial perfusion imaging, coronary angiography, C-reactive protein (CRP), glycated hemoglobin (HbA1C), total serum cholesterol, duplex ultrasonography, digital subtraction angiography, magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography, and ankle-brachial index (ABI) independently predict the risks and prognostic outcomes in asymptomatic cardiovascular disease (CVD) patients. The peripheral artery disease (PAD) screening guides the diagnosis, management, and prognosis of hemodynamically significant arterial stenosis, calcification, and malignant hypertension in patients with CVD without symptoms. The 79% sensitivity and 96% specificity of ABI screening, 90% sensitivity and 97% specificity of MRA, and 95% sensitivity and 50% specificity of CTA for tracking arterial occlusion indicate the high prognostic value of these tests in the setting of CVD. The 85% specificity and 60-70% sensitivity of cardiac stress testing substantiate its suitability to determine asymptomatic CVD prognosis related to myocardial ischemia, heart failure, multivessel disease, and unstable angina. The carotid duplex ultrasound potentially identifies long-term mortality, stroke, atherosclerosis, plaque instability, and angiographic stenosis among asymptomatic CVD patients with 94% specificity and 90% sensitivity. The CAC scoring has a positive predictive value (PPV) of 45.7% for identifying aortic valve calcium and PPV of 79.3% for tracking thoracic artery calcium. The medical literature provides substantial evidence concerning the validity, reliability, and prognostic value of cardiovascular testing for asymptomatic patients. Future studies are needed to undertake detailed assessments of benefits versus adverse outcomes associated with the prospective scaling (of cardiovascular testing) across asymptomatic CVD patients.
Highlights
More than one-third of mortality in the United States reportedly occurs under the impact of cardiovascular disease (CVD) that majorly includes aortic atherosclerosis, peripheral artery disease (PAD), cerebrovascular disease, and coronary heart disease/coronary artery disease (CAD) [1]
Exercise stress test results showing less than 1 mm ST depression in accordance with the three-minutes Bruce protocol correlates with a CVD mortality rate of less than 1%; while a 5% annual CVD mortality rate correlates with ST depression (≥1 mm) in scenarios where the asymptomatic patients fail to accomplish the first phase of the Bruce protocol[19]
Cardiovascular tests discussed include both invasive testing with risk of contrast side effects and non-invasive testings with minimal side effects
Summary
More than one-third of mortality in the United States reportedly occurs under the impact of cardiovascular disease (CVD) that majorly includes aortic atherosclerosis, peripheral artery disease (PAD), cerebrovascular disease, and coronary heart disease/coronary artery disease (CAD) [1]. Coronary angiography detects major adverse cardiac events (MACE) that help determine the long/mid-term prognosis of asymptomatic patients This diagnostic modality predicts the risk of MI/non-ST segment elevation MI (NSTEMI), cardiovascular mortality, non-obstructive CAD, and unstable angina/acute coronary syndrome in the setting of CVD[43]. The clinical correlation of coronary angiography findings with smoking history, systolic blood pressure, cholesterol levels, ethnicity, and age of the asymptomatic CVD patients further guides their prognosis and risk stratification[48]. Clinical correlation of elevated high sensitivity CRP levels with the medical history of obesity, dyslipidemia, diabetes/hyperglycemia, hypertension, and hypercholesterolemia guides the prognostication of MACE and cardiovascular mortality across asymptomatic CVD patients. They emphasize the prognostication of CAD severity and adverse outcomes guided by baseline HbA1C elevation[58]
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