ESR Essentials: imaging in stable chest pain – practice recommendations by ESCR
Stable chest pain is a common symptom with multiple potential causes. Non-invasive imaging has an important role in diagnosis and guiding management through the assessment of coronary stenoses, atherosclerotic plaque, myocardial ischaemia or infarction, and cardiac function. Computed tomography (CT)...
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| Veröffentlicht in: | European radiology 2024-10, Vol.34 (10), p.6559-6567 |
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| creator | Muscogiuri, Giuseppe Weir-McCall, Jonathan R. Tregubova, Mariia Ley, Sebastian Loewe, Christian Alkadhi, Hatem Salgado, Rodrigo Vliegenthart, Rozemarijn Williams, Michelle C. |
| description | Stable chest pain is a common symptom with multiple potential causes. Non-invasive imaging has an important role in diagnosis and guiding management through the assessment of coronary stenoses, atherosclerotic plaque, myocardial ischaemia or infarction, and cardiac function. Computed tomography (CT) provides the anatomical evaluation of coronary artery disease (CAD) with the assessment of stenosis, plaque type and plaque burden, with additional functional information available from CT fractional flow reserve (FFR) or CT myocardial perfusion imaging. Stress magnetic resonance imaging, nuclear stress myocardial perfusion imaging, and stress echocardiography can assess myocardial ischaemia and other cardiac functional parameters. Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. Functional testing may be considered for patients with known CAD, where the clinical significance is uncertain based on anatomical testing, or in patients with high pre-test probability. This practice recommendations document can be used to guide the selection of non-invasive imaging for patients with stable chest pain and provides brief recommendations on how to perform and report these diagnostic tests.
Key Points
The selection of non-invasive imaging tests for patients with stable chest pain should be based on symptoms, pre-test probability, and previous history
.
Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability
.
Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability
.
Key recommendations
Non-invasive imaging is an important part of the assessment of patients with stable chest pain. The selection of non-invasive imaging test should be based on symptoms, pre-test probability, and previous history. (Level of evidence: High).
Coronary CT angiography can be used as a first line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. CT provides information on stenoses, plaque type, plaque volume, and if required functional information with CT fractional flow reserve or CT perfusion. (Level of evidence: High).
Functional testing can be considered for patients with know |
| doi_str_mv | 10.1007/s00330-024-10739-y |
| format | Article |
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Key Points
The selection of non-invasive imaging tests for patients with stable chest pain should be based on symptoms, pre-test probability, and previous history
.
Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability
.
Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability
.
Key recommendations
Non-invasive imaging is an important part of the assessment of patients with stable chest pain. The selection of non-invasive imaging test should be based on symptoms, pre-test probability, and previous history. (Level of evidence: High).
Coronary CT angiography can be used as a first line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. CT provides information on stenoses, plaque type, plaque volume, and if required functional information with CT fractional flow reserve or CT perfusion. (Level of evidence: High).
Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability. Stress MRI, SPECT, PET, and echocardiography can provide information on myocardial ischemia, along with cardiac functional and other information. (Level of evidence: Medium).</description><identifier>ISSN: 1432-1084</identifier><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-024-10739-y</identifier><identifier>PMID: 38625611</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Angiography ; Arteriosclerosis ; Atherosclerosis ; Cardiovascular disease ; Chest ; Chest Pain - diagnostic imaging ; Chest Pain - etiology ; Clinical significance ; Computed tomography ; Computed Tomography Angiography - methods ; Coronary Angiography - methods ; Coronary artery disease ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnostic imaging ; Diagnostic Radiology ; Echocardiography ; Functional testing ; Humans ; Imaging ; Infarction ; Internal Medicine ; Interventional Radiology ; Invited Review ; Ischemia ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Medical imaging ; Medicine ; Medicine & Public Health ; Myocardial ischemia ; Myocardial Perfusion Imaging - methods ; Neuroradiology ; Pain ; Perfusion ; Positron emission ; Radiology ; Signs and symptoms ; Single photon emission computed tomography ; Stenosis ; Tomography, X-Ray Computed - methods ; Ultrasound</subject><ispartof>European radiology, 2024-10, Vol.34 (10), p.6559-6567</ispartof><rights>The Author(s), under exclusive licence to European Society of Radiology 2024. corrected publication 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to European Society of Radiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-1ebd3917e24c6b24d906ed626fe39592f8638c1305e9b49aa93dc7bee5d05fc13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-024-10739-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-024-10739-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38625611$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muscogiuri, Giuseppe</creatorcontrib><creatorcontrib>Weir-McCall, Jonathan R.</creatorcontrib><creatorcontrib>Tregubova, Mariia</creatorcontrib><creatorcontrib>Ley, Sebastian</creatorcontrib><creatorcontrib>Loewe, Christian</creatorcontrib><creatorcontrib>Alkadhi, Hatem</creatorcontrib><creatorcontrib>Salgado, Rodrigo</creatorcontrib><creatorcontrib>Vliegenthart, Rozemarijn</creatorcontrib><creatorcontrib>Williams, Michelle C.</creatorcontrib><title>ESR Essentials: imaging in stable chest pain – practice recommendations by ESCR</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Stable chest pain is a common symptom with multiple potential causes. Non-invasive imaging has an important role in diagnosis and guiding management through the assessment of coronary stenoses, atherosclerotic plaque, myocardial ischaemia or infarction, and cardiac function. Computed tomography (CT) provides the anatomical evaluation of coronary artery disease (CAD) with the assessment of stenosis, plaque type and plaque burden, with additional functional information available from CT fractional flow reserve (FFR) or CT myocardial perfusion imaging. Stress magnetic resonance imaging, nuclear stress myocardial perfusion imaging, and stress echocardiography can assess myocardial ischaemia and other cardiac functional parameters. Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. Functional testing may be considered for patients with known CAD, where the clinical significance is uncertain based on anatomical testing, or in patients with high pre-test probability. This practice recommendations document can be used to guide the selection of non-invasive imaging for patients with stable chest pain and provides brief recommendations on how to perform and report these diagnostic tests.
Key Points
The selection of non-invasive imaging tests for patients with stable chest pain should be based on symptoms, pre-test probability, and previous history
.
Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability
.
Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability
.
Key recommendations
Non-invasive imaging is an important part of the assessment of patients with stable chest pain. The selection of non-invasive imaging test should be based on symptoms, pre-test probability, and previous history. (Level of evidence: High).
Coronary CT angiography can be used as a first line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. CT provides information on stenoses, plaque type, plaque volume, and if required functional information with CT fractional flow reserve or CT perfusion. (Level of evidence: High).
Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability. Stress MRI, SPECT, PET, and echocardiography can provide information on myocardial ischemia, along with cardiac functional and other information. (Level of evidence: Medium).</description><subject>Angiography</subject><subject>Arteriosclerosis</subject><subject>Atherosclerosis</subject><subject>Cardiovascular disease</subject><subject>Chest</subject><subject>Chest Pain - diagnostic imaging</subject><subject>Chest Pain - etiology</subject><subject>Clinical significance</subject><subject>Computed tomography</subject><subject>Computed Tomography Angiography - methods</subject><subject>Coronary Angiography - methods</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Diagnostic Radiology</subject><subject>Echocardiography</subject><subject>Functional testing</subject><subject>Humans</subject><subject>Imaging</subject><subject>Infarction</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Invited Review</subject><subject>Ischemia</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Myocardial ischemia</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>Neuroradiology</subject><subject>Pain</subject><subject>Perfusion</subject><subject>Positron emission</subject><subject>Radiology</subject><subject>Signs and symptoms</subject><subject>Single photon emission computed tomography</subject><subject>Stenosis</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Ultrasound</subject><issn>1432-1084</issn><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kLlOAzEQhi0EIiHwAhTIEg3Nwtjey3QoCoeEhEigtrze2bDRXtibIh3vwBvyJBgSDlFQ-Zhv_hl9hBwyOGUAyZkDEAIC4GHAIBEyWG2RIQsF98803P51H5A95xYAIFmY7JKBSGMexYwNyf1kNqUT57DpS125c1rWel42c1o21PU6q5CaJ3Q97bT_eXt5pZ3Vpi8NUoumrWtsct2XbeNotqKT2Xi6T3YKn4QHm3NEHi8nD-Pr4Pbu6mZ8cRsYweM-YJjlQrIEeWjijIe5hBjzmMcFChlJXqSxSA0TEKHMQqm1FLlJMsQoh6jwhRE5Wed2tn1e-hVVXTqDVaUbbJdOCRAyBZkkkUeP_6CLdmkbv50SDEKeMJaCp_iaMrZ1zmKhOutt2JVioD6Eq7Vw5YWrT-Fq5ZuONtHLrMb8u-XLsAfEGnC-1MzR_sz-J_Yd2e-LJg</recordid><startdate>202410</startdate><enddate>202410</enddate><creator>Muscogiuri, Giuseppe</creator><creator>Weir-McCall, Jonathan R.</creator><creator>Tregubova, Mariia</creator><creator>Ley, Sebastian</creator><creator>Loewe, Christian</creator><creator>Alkadhi, Hatem</creator><creator>Salgado, Rodrigo</creator><creator>Vliegenthart, Rozemarijn</creator><creator>Williams, Michelle C.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>202410</creationdate><title>ESR Essentials: imaging in stable chest pain – practice recommendations by ESCR</title><author>Muscogiuri, Giuseppe ; Weir-McCall, Jonathan R. ; Tregubova, Mariia ; Ley, Sebastian ; Loewe, Christian ; Alkadhi, Hatem ; Salgado, Rodrigo ; Vliegenthart, Rozemarijn ; Williams, Michelle C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-1ebd3917e24c6b24d906ed626fe39592f8638c1305e9b49aa93dc7bee5d05fc13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Angiography</topic><topic>Arteriosclerosis</topic><topic>Atherosclerosis</topic><topic>Cardiovascular disease</topic><topic>Chest</topic><topic>Chest Pain - diagnostic imaging</topic><topic>Chest Pain - etiology</topic><topic>Clinical significance</topic><topic>Computed tomography</topic><topic>Computed Tomography Angiography - methods</topic><topic>Coronary Angiography - methods</topic><topic>Coronary artery disease</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Diagnostic Radiology</topic><topic>Echocardiography</topic><topic>Functional testing</topic><topic>Humans</topic><topic>Imaging</topic><topic>Infarction</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Invited Review</topic><topic>Ischemia</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Myocardial ischemia</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>Neuroradiology</topic><topic>Pain</topic><topic>Perfusion</topic><topic>Positron emission</topic><topic>Radiology</topic><topic>Signs and symptoms</topic><topic>Single photon emission computed tomography</topic><topic>Stenosis</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Muscogiuri, Giuseppe</creatorcontrib><creatorcontrib>Weir-McCall, Jonathan R.</creatorcontrib><creatorcontrib>Tregubova, Mariia</creatorcontrib><creatorcontrib>Ley, Sebastian</creatorcontrib><creatorcontrib>Loewe, Christian</creatorcontrib><creatorcontrib>Alkadhi, Hatem</creatorcontrib><creatorcontrib>Salgado, Rodrigo</creatorcontrib><creatorcontrib>Vliegenthart, Rozemarijn</creatorcontrib><creatorcontrib>Williams, Michelle C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Muscogiuri, Giuseppe</au><au>Weir-McCall, Jonathan R.</au><au>Tregubova, Mariia</au><au>Ley, Sebastian</au><au>Loewe, Christian</au><au>Alkadhi, Hatem</au><au>Salgado, Rodrigo</au><au>Vliegenthart, Rozemarijn</au><au>Williams, Michelle C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ESR Essentials: imaging in stable chest pain – practice recommendations by ESCR</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2024-10</date><risdate>2024</risdate><volume>34</volume><issue>10</issue><spage>6559</spage><epage>6567</epage><pages>6559-6567</pages><issn>1432-1084</issn><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Stable chest pain is a common symptom with multiple potential causes. Non-invasive imaging has an important role in diagnosis and guiding management through the assessment of coronary stenoses, atherosclerotic plaque, myocardial ischaemia or infarction, and cardiac function. Computed tomography (CT) provides the anatomical evaluation of coronary artery disease (CAD) with the assessment of stenosis, plaque type and plaque burden, with additional functional information available from CT fractional flow reserve (FFR) or CT myocardial perfusion imaging. Stress magnetic resonance imaging, nuclear stress myocardial perfusion imaging, and stress echocardiography can assess myocardial ischaemia and other cardiac functional parameters. Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. Functional testing may be considered for patients with known CAD, where the clinical significance is uncertain based on anatomical testing, or in patients with high pre-test probability. This practice recommendations document can be used to guide the selection of non-invasive imaging for patients with stable chest pain and provides brief recommendations on how to perform and report these diagnostic tests.
Key Points
The selection of non-invasive imaging tests for patients with stable chest pain should be based on symptoms, pre-test probability, and previous history
.
Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability
.
Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability
.
Key recommendations
Non-invasive imaging is an important part of the assessment of patients with stable chest pain. The selection of non-invasive imaging test should be based on symptoms, pre-test probability, and previous history. (Level of evidence: High).
Coronary CT angiography can be used as a first line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. CT provides information on stenoses, plaque type, plaque volume, and if required functional information with CT fractional flow reserve or CT perfusion. (Level of evidence: High).
Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability. Stress MRI, SPECT, PET, and echocardiography can provide information on myocardial ischemia, along with cardiac functional and other information. (Level of evidence: Medium).</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38625611</pmid><doi>10.1007/s00330-024-10739-y</doi><tpages>9</tpages></addata></record> |
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| subjects | Angiography Arteriosclerosis Atherosclerosis Cardiovascular disease Chest Chest Pain - diagnostic imaging Chest Pain - etiology Clinical significance Computed tomography Computed Tomography Angiography - methods Coronary Angiography - methods Coronary artery disease Coronary Artery Disease - complications Coronary Artery Disease - diagnostic imaging Diagnostic Radiology Echocardiography Functional testing Humans Imaging Infarction Internal Medicine Interventional Radiology Invited Review Ischemia Magnetic resonance imaging Magnetic Resonance Imaging - methods Medical imaging Medicine Medicine & Public Health Myocardial ischemia Myocardial Perfusion Imaging - methods Neuroradiology Pain Perfusion Positron emission Radiology Signs and symptoms Single photon emission computed tomography Stenosis Tomography, X-Ray Computed - methods Ultrasound |
| title | ESR Essentials: imaging in stable chest pain – practice recommendations by ESCR |
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