1/ Great #ASPC2021 session by @RonBlankstein on Chest Pain and Imaging
Follow this🧵for some takeaways on
🟣Stress Testing vs. Anatomical Testing
🟣Coronary CTA
🟣Guidelines
@ASPCardio @CardioNerds
2/ ‼️ Imaging tests alone do NOT change pt outcomes but how we act on them might
‼️ No one test is always the best test
‼️ Test selection influenced by multiple factors: local availability, prior training, guidelines, evidence
🔜AHA/ACC New Chest Pain Guidelines
#ASPC2021
3/ Stress testing vs. Anatomical
ETT: exercise capacity, not as great for ischemia
SPECT MPI: reversible perfusion deficits, underestimates extent of disease esp if multi-vessel
PET MPI: measure absolute blood flow, calculate myocardial blood flow reserve
#ASPC2021
4/ CCTA can detect plaque #ASPC2021
Why is plaque identification important?
🔹Most stress tests are normal bit.ly/2VaSPLP
🔹Normal functional study➡️events still occur
5/🔥PROMISE study🔥
Stable chest pain & low burden of obstructive CAD,
CCTA more prognostic than functional testing bit.ly/3zw6z2C
Plaque burden predicts risk better than stenosis
journalofcardiovascularct.com/article/S1934-… @Heart_SCCT
#ASPC2021
6/ SCOT HEART study – CCTA had reduction in CHD/MI compared to ETT bit.ly/3BC10kZ
Risk assessment by CT – not just for statins
In future, can guide PCSK9, BP control, antiplatelet, lifestyle changes, amongst others
#ASPC2021
7/ What matters most? #ASPC2021
🔹Overall amount of plaque
🔹High risk plaque
🔹Peri-coronary fat attenuation
🔹Hemodynamic significance
🔹Shear stress
🔹Underlying risk factors, in future polygenic risk scores
Limitations – functional significance of lesions is uncertain
8/ If high clinical likelihood of ischemia or obstructive CAD – refer for functional testing
How to identify those patients?
➡️Men older than 70 w/ typical angina
CCTA
-useful for no known CAD
-not useful for known CAD, massive CAC, morbid obesity, small stents
#ASPC2021
9/ Summary: how do we select best test?
🔹Known CAD vs. no known CAD
🔹Local expertise
🔹Results of prior imaging tests
Known multi-vessel disease – SPECT not preferred
Other cardiac pathologies – cardiac MRI useful for pericarditis, non-ischemic cardiomyopathy eval
#ASPC2021
10/ Check out infographics by @CardioNerds on cardiovascular imaging here:
cardionerds.com/infographics/
#ASPC2021
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