Comparison of Clinical Efficacy and Cost of a Cardiac Imaging Strategy Versus a Traditional Exercise Test Strategy for the Investigation of Patients With Suspected Stable Coronary Artery Disease

Demir, Ozan M.; Bashir, Abdullah; Marshall, Kathy; Douglas, Martina; Wasan, Balvinder; Plein, Sven; Alfakih, Khaled

doi:10.1016/j.amjcard.2015.03.005

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…The second used a “cardiac imaging” pathway that involved a combination of coronary artery calcium score, CCTA, MPI, and stress echo. They concluded that the cardiac imaging strategy resulted in fewer invasive angiograms and a higher yield of obstructive CAD 10. They did not analyze the yield of obstructive CAD among the different testing modalities in the imaging arm.…”

Section: Discussionmentioning

confidence: 99%

“…The yield of obstructive CAD based on downstream invasive angiography has recently been used as an outcome measure in studies designed to assess the clinical effectiveness of noninvasive cardiac diagnostic tests 8, 9, 10. Recent registry data suggest that only ≈38% of those referred for invasive angiography in the United States for the diagnosis of SCAD had obstructive CAD on invasive angiography 11, 12.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

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BackgroundThe optimal initial noninvasive diagnostic testing strategy for stable coronary artery disease (CAD) is unknown. Although American guidelines recommend an exercise stress test as the first‐line test, European guidelines suggest that stress imaging (myocardial perfusion imaging or stress echocardiography) or coronary computed tomography angiography may be preferable. Understanding the relationship between the initial strategy and downstream yield of obstructive CAD and major adverse cardiac events may provide insight as to the optimal strategy.Methods and ResultsWe conducted a population‐based retrospective cohort study of adults in Ontario, Canada, using health administrative and clinical data. The relationship between the initial testing strategy and obstructive CAD on invasive angiography was examined. Patients were then followed from their angiogram onward to determine whether they developed a composite end point of major adverse cardiac events. After adjusting for covariates, patients with initial myocardial perfusion imaging (odds ratio: 0.92; 95% confidence interval, 0.85, 1.00), coronary computed tomography angiography (odds ratio: 1.51; 95% confidence interval, 0.91, 2.49), or stress echo (odds ratio: 0.95; 95% confidence interval, 0.84, 1.08) did not a have significantly different yield of obstructive CAD compared with those with an initial exercise stress test. Furthermore, there was no significant difference in downstream major adverse cardiac events after invasive angiography among the 4 initial testing strategies after adjusting for clinically relevant covariates.ConclusionsOur study found no evidence to suggest significant differences in either yield of obstructive CAD or downstream major adverse cardiac events in patients undergoing an initial noninvasive testing strategy with stress or anatomical imaging compared with those undergoing an initial exercise stress test.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

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“…Regardless there may be an opportunity to improve care by prioritizing efforts to make sure that patients undergo appropriate risk stratification prior to the performance of coronary angiography. 15,16 …”

Section: Discussionmentioning

confidence: 99%

Coronary Catheterization and Percutaneous Coronary Intervention in China

Zheng

Curtis

et al. 2016

JAMA Intern Med

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“…Combining exercise stress testing with cardiac imaging, such as echocardiography, nuclear imaging, or positron emission tomography, significantly improves diagnostic sensitivity and specificity (6,27,29,35,60). Accordingly, exercise stress imaging is commonly performed world-wide (12,14,15,52,62).…”

Section: Introductionmentioning

confidence: 99%

Exercise cardiac magnetic resonance imaging: a feasibility study and meta-analysis

Beaudry

Samuel

Wang

et al. 2018

American Journal of Physiology-Regulatory, Integrative and Comp

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Cardiac stress testing improves detection and risk assessment of heart disease. Magnetic resonance imaging (MRI) is the clinical gold-standard for assessing cardiac morphology and function at rest; however, exercise MRI has not been widely adapted for cardiac assessment because of imaging and device limitations. Commercially available magnetic resonance ergometers, together with improved imaging sequences, have overcome many previous limitations, making cardiac stress MRI more feasible. Here, we aimed to demonstrate clinical feasibility and establish the normative, healthy response to supine exercise MRI. Eight young, healthy subjects underwent rest and exercise cinematic imaging to measure left ventricular volumes and ejection fraction. To establish the normative, healthy response to exercise MRI we performed a comprehensive literature review and meta-analysis of existing exercise cardiac MRI studies. Results were pooled using a random effects model to define the left ventricular ejection fraction, end-diastolic, end-systolic, and stroke volume responses. Our proof-of-concept data showed a marked increase in cardiac index with exercise, secondary to an increase in both heart rate and stroke volume. The change in stroke volume was driven by a reduction in end-systolic volume, with no change in end-diastolic volume. These findings were entirely consistent with 17 previous exercise MRI studies (226 individual records), despite differences in imaging approach, ergometer, or exercise type. Taken together, the data herein demonstrate that exercise cardiac MRI is clinically feasible, using commercially available exercise equipment and vendor-provided product sequences and establish the normative, healthy response to exercise MRI.

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Comparison of Clinical Efficacy and Cost of a Cardiac Imaging Strategy Versus a Traditional Exercise Test Strategy for the Investigation of Patients With Suspected Stable Coronary Artery Disease

Cited by 7 publications

References 15 publications

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Coronary Catheterization and Percutaneous Coronary Intervention in China

Exercise cardiac magnetic resonance imaging: a feasibility study and meta-analysis

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