While the Choosing Wisely campaign is perhaps the most widely recognized of these professional efforts to self-regulate use of low-value tests and procedures, it was preceded and informed, in part, by the American College of Cardiology’s (ACC) development of appropriate use criteria (AUC) for cardiac imaging stress tests. Professional society organizations and clinical researchers have also taken steps to better characterize the value of cardiac imaging, while also highlighting clinical scenarios under which imaging use is particularly low-value and unlikely to improve patients’ health or management. All rights reserved.Cardiac imaging has advanced physicians’ ability to diagnose and treat a variety of diseases, but rapid growth in the utilization and cost of imaging technology has spurred public and private insurers to scrutinize its use and construct policies aimed at reducing imaging expenditures. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.Ĭopyright © 2013 American College of Cardiology Foundation. Both approaches yield a very good accuracy. MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded.

These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%).

Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤ 0.80 in vessels >2mm. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD.ġ01 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD).

Reference tool for cardiac stress test