Thread by @Gurleen_Kaur96

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