Chronic stable angina electron beam tomography: Difference between revisions
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==Overview== | ==Overview== | ||
The extent of coronary artery calcification directly correlates to the area of atheromatous plaque <ref name="pmid7554196">Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7554196 Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study.] ''Circulation'' 92 (8):2157-62. PMID: [http://pubmed.gov/7554196 7554196]</ref>. Hence in patients with [[chest pain]], | The extent of coronary artery calcification directly correlates to the area of atheromatous plaque <ref name="pmid7554196">Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7554196 Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study.] ''Circulation'' 92 (8):2157-62. PMID: [http://pubmed.gov/7554196 7554196]</ref>. Hence in patients with [[chest pain]], coronary artery calcium (CAC) scoring is one of the factor to be considered in the risk assessment for [[coronary artery disease]]. The methods used for detection and quantification of CAC include electron beam computed tomography (EBCT) and multi-detector computed tomography (MDCT) <ref name="pmid17239724">Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17239724 ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography.] ''J Am Coll Cardiol'' 49 (3):378-402. [http://dx.doi.org/10.1016/j.jacc.2006.10.001 DOI:10.1016/j.jacc.2006.10.001] PMID: [http://pubmed.gov/17239724 17239724]</ref>. Agatston score is a computed software that is commonly used to measure CAC based on the density and area of calcified plaques <ref name="pmid2407762">Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2407762 Quantification of coronary artery calcium using ultrafast computed tomography.] ''J Am Coll Cardiol'' 15 (4):827-32. PMID: [http://pubmed.gov/2407762 2407762]</ref>. | ||
==Indications== | ==Indications== | ||
*Ultrafast computed tomography can be used to | *Ultrafast computed tomography can be used to detect coronary calcifications, which often precede symptomatic coronary artery stenosis. However, coronary calcification is also observed in patients without important [[coronary artery disease]] at angiography. | ||
*CT angiography used for the detection of [[CAD]], has a | *CT angiography used for the detection of [[CAD]], has a negative predictive value of 93-99%, sensitivity of 90-94% and specificity of 95-97% <ref name="pmid15840624">Leschka S, Alkadhi H, Plass A, Desbiolles L, Grünenfelder J, Marincek B et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15840624 Accuracy of MSCT coronary angiography with 64-slice technology: first experience.] ''Eur Heart J'' 26 (15):1482-7. [http://dx.doi.org/10.1093/eurheartj/ehi261 DOI:10.1093/eurheartj/ehi261] PMID: [http://pubmed.gov/15840624 15840624]</ref> <ref name="pmid16053973">Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16053973 Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography.] ''J Am Coll Cardiol'' 46 (3):552-7. [http://dx.doi.org/10.1016/j.jacc.2005.05.056 DOI:10.1016/j.jacc.2005.05.056] PMID: [http://pubmed.gov/16053973 16053973]</ref>. | ||
*CT angiography is indicated in patients with a [[Chronic stable angina assessing the pretest probability of coronary artery disease|low pretest probability]] of [[CAD]] (less than 10%) or in patients with non conclusive [[Chronic stable angina exercise electrocardiography|exercise ECG]] or stress test. | *CT angiography is indicated in patients with a [[Chronic stable angina assessing the pretest probability of coronary artery disease|low pretest probability]] of [[CAD]] (less than 10%) or in patients with non conclusive [[Chronic stable angina exercise electrocardiography|exercise ECG]] or stress test. | ||
*Although this test has generated substantial interest and publicity, the current lack of information from large scale assessments make it | *Although this test has generated substantial interest and publicity, the current lack of information from large scale assessments make it premature to recommend its use in routine clinical care. | ||
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (Do Not Edit)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980 }} </ref>== | ==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (Do Not Edit)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980 }} </ref>== | ||
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===[[European society of cardiology#Classes of Recommendations|Class IIb]]=== | ===[[European society of cardiology#Classes of Recommendations|Class IIb]]=== | ||
'''1.''' Patients with a [[Chronic stable angina assessing the pretest probability of coronary artery disease|low pre-test probability]] of [[CAD]], with a non-conclusive [[Chronic stable angina exercise electrocardiography|exercise ECG]] or [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|stress imaging]] test. ''(Level of Evidence: C)''}} | '''1.''' Patients with a [[Chronic stable angina assessing the pretest probability of coronary artery disease|low pre-test probability]] of [[CAD]], with a non-conclusive [[Chronic stable angina exercise electrocardiography|exercise ECG]] or [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|stress imaging]] test. ''(Level of Evidence: C)''}} | ||
==References== | ==References== | ||
Revision as of 20:55, 18 January 2013
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina electron beam tomography On the Web | ||
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to Hospitals Treating Chronic stable angina electron beam tomography | ||
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Risk calculators and risk factors for Chronic stable angina electron beam tomography | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.
Synonyms and keywords: Ultrafast Computed Tomography; EBCT
Overview
The extent of coronary artery calcification directly correlates to the area of atheromatous plaque [1]. Hence in patients with chest pain, coronary artery calcium (CAC) scoring is one of the factor to be considered in the risk assessment for coronary artery disease. The methods used for detection and quantification of CAC include electron beam computed tomography (EBCT) and multi-detector computed tomography (MDCT) [2]. Agatston score is a computed software that is commonly used to measure CAC based on the density and area of calcified plaques [3].
Indications
- Ultrafast computed tomography can be used to detect coronary calcifications, which often precede symptomatic coronary artery stenosis. However, coronary calcification is also observed in patients without important coronary artery disease at angiography.
- CT angiography used for the detection of CAD, has a negative predictive value of 93-99%, sensitivity of 90-94% and specificity of 95-97% [4] [5].
- CT angiography is indicated in patients with a low pretest probability of CAD (less than 10%) or in patients with non conclusive exercise ECG or stress test.
- Although this test has generated substantial interest and publicity, the current lack of information from large scale assessments make it premature to recommend its use in routine clinical care.
ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (Do Not Edit)[6]
Noninvasive Testing-Electron Beam Tomography (Do Not Edit)[6]
| Class IIb |
| "1. Electron beam computed tomography. (Level of Evidence:B)" |
ESC Guidelines- Computed tomography in patients with chronic stable angina (DO NOT EDIT) [7]
| “ |
Class IIb1. Patients with a low pre-test probability of CAD, with a non-conclusive exercise ECG or stress imaging test. (Level of Evidence: C) |
” |
References
- ↑ Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92 (8):2157-62. PMID: 7554196
- ↑ Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM et al. (2007) ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 49 (3):378-402. DOI:10.1016/j.jacc.2006.10.001 PMID: 17239724
- ↑ Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15 (4):827-32. PMID: 2407762
- ↑ Leschka S, Alkadhi H, Plass A, Desbiolles L, Grünenfelder J, Marincek B et al. (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26 (15):1482-7. DOI:10.1093/eurheartj/ehi261 PMID: 15840624
- ↑ Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46 (3):552-7. DOI:10.1016/j.jacc.2005.05.056 PMID: 16053973
- ↑ 6.0 6.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM; et al. (1999). "ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina)". Circulation. 99 (21): 2829–48. PMID 10351980.
- ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.