Prognostic Value of Cardiovascular Testing in Asymptomatic Patients With a History of Cardiovascular Disease: A Review of Contemporary Medical Literature

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.

The Relationship Between the Causes of Cardiovascular Diseases

“…The mortality rate from cardiovascular disease increases with age. This is due to the slow and irreversible process of atherosclerosis, where cholesterol builds up in the inner walls of blood vessels causing arteries to gradually harden and blood flow to become lower and lower, which causes inadequate blood supply to vital organs such as the heart, brain and kidneys, leading to conditions such as myocardial infarction, stroke and hypertension [5,6]. Currently, more than 16% of China's population is aged 60 years or older, and this proportion is expected to increase to 35% by 2050.…”

Heart Rate Response to Exercise and Recovery

“…[3][4][5][6][7] In recent years, the role of exercise electrocardiogram in the diagnostic evaluation of chronic coronary syndromes is diminishing, whereas noninvasive imaging modalities such as coronary computed tomography angiography are often recommended to diagnose obstructive coronary artery disease. 8,9 Nevertheless, much information is obtained during ET beyond electrocardiographic-related changes and regardless of the test indication, which may have important diagnostic and prognostic implications. These data, associated with the physiologic response to exercise, include estimates of CRF such as ET time and metabolic equivalents (METs) achieved, as well as heart rate (HR) and blood pressure response to exercise and recovery.…”

“…It has additional clinical applications, including the assessment of cardiorespiratory fitness (CRF) and the presence of arrhythmia, in diverse patient populations 3–7. In recent years, the role of exercise electrocardiogram in the diagnostic evaluation of chronic coronary syndromes is diminishing, whereas noninvasive imaging modalities such as coronary computed tomography angiography are often recommended to diagnose obstructive coronary artery disease 8,9. Nevertheless, much information is obtained during ET beyond electrocardiographic-related changes and regardless of the test indication, which may have important diagnostic and prognostic implications.…”

Coronary Artery Magnetic Resonance Angiography Combined with Computed Tomography Angiography in Diagnosis of Coronary Heart Disease by Reconstruction Algorithm

“…CTA is a noninvasive inspection method to determine the degree of coronary artery stenosis (CAS) and its branches. If there is no stenosis on the coronary CT angiography, the invasive inspection is generally not necessary [ 5 , 6 ]. Magnetic resonance angiography (MRA) is an examination method that uses electromagnetic waves to generate images of two-dimensional or three-dimensional structures of the body, and uses magnetic resonance phenomena to obtain electromagnetic signals from the human body and reconstruct human information [ 7 ].…”