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Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

  • Cardiac Computed Tomography (TC Villines, Section Editor)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many health care systems rely on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows for the accurate noninvasive visualization of coronary artery disease, challenging the role of stress testing as the default noninvasive imaging tool for evaluating patients with chest pain. In this review, we summarize current data on the clinical utility of cardiac computed tomography and stress testing in stable patients with suspected coronary artery disease.

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Abbreviations

ACS:

Acute coronary syndrome

AUC:

Area under the curve

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CCTA:

Cardiac computed tomography angiography

ECG:

Electrocardiogram

ICA:

Invasive coronary angiography

MACE:

Major adverse cardiac event

MDCT:

Multidetector computed tomography

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

NPV:

Negative predictive value

PCI:

Percutaneous intervention

PPV:

Positive predicative value

RCT:

Randomized clinical trial

SPECT:

Single-photon emission computerized tomography

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322.

    Article  PubMed  Google Scholar 

  2. Arbab-Zadeh A, Texter J, Ostbye KM, Kitagawa K, Brinker J, George RT, et al. Quantification of lumen stenoses with known dimensions by conventional angiography and computed tomography: implications of using conventional angiography as gold standard. Heart. 2010;96(17):1358–63.

    Article  CAS  PubMed  Google Scholar 

  3. Arbab-Zadeh A, Hoe J. Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography methods, caveats, and implications. JACC Cardiovasc Imaging. 2011;4(2):191–202.

    Article  PubMed  Google Scholar 

  4. Fleischmann KE, Hunink MG, Kuntz KM, Douglas PS. Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. JAMA. 1998;280(10):913–20.

    Article  CAS  PubMed  Google Scholar 

  5. Geleijnse ML, Krenning BJ, van Dalen BM, Nemes A, Soliman OI, Bosch JG, et al. Factors affecting sensitivity and specificity of diagnostic testing: dobutamine stress echocardiography. J Am Soc Echocardiogr. 2009;22(11):1199–208.

    Article  PubMed  Google Scholar 

  6. Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989;80(1):87–98.

    Article  CAS  PubMed  Google Scholar 

  7. Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ, Harbinson M, et al. Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging. 2004;31(2):261–91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Kim C, Kwok YS, Heagerty P, Redberg R. Pharmacologic stress testing for coronary disease diagnosis: a meta-analysis. Am Heart J. 2001;142(6):934–44.

    Article  CAS  PubMed  Google Scholar 

  9. Arbab-Zadeh A. Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm. Heart Int. 2012;7(1), e2.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Sharma A, Arbab-Zadeh A. Assessment of coronary heart disease by CT angiography: current and evolving applications. J Nucl Cardiol. 2012;19(4):796–806.

    Article  PubMed  Google Scholar 

  11. Froelicher VF, Lehmann KG, Thomas R, Goldman S, Morrison D, Edson R, et al. The electrocardiographic exercise test in a population with reduced workup bias: diagnostic performance, computerized interpretation, and multivariable prediction. Veterans Affairs Cooperative Study in Health Services #016 (QUEXTA) Study Group. Quantitative Exercise Testing and Angiography. Ann Intern Med. 1998;128(12 Pt 1):965–74.

    Article  CAS  PubMed  Google Scholar 

  12. Miller TD, Hodge DO, Christian TF, Milavetz JJ, Bailey KR, Gibbons RJ. Effects of adjustment for referral bias on the sensitivity and specificity of single photon emission computed tomography for the diagnosis of coronary artery disease. Am J Med. 2002;112(4):290–7.

    Article  PubMed  Google Scholar 

  13. Roger VL, Pellikka PA, Bell MR, Chow CW, Bailey KR, Seward JB. Sex and test verification bias. Impact on the diagnostic value of exercise echocardiography. Circulation. 1997;95(2):405–10.

    Article  CAS  PubMed  Google Scholar 

  14. Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H, et al. MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 2008;29(4):480–9.

    Article  PubMed  Google Scholar 

  15. Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K, et al. MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial. Eur Heart J. 2013;34(10):775–81.

    Article  PubMed  Google Scholar 

  16. Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379(9814):453–60.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Paech DC, Weston AR. A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease. BMC Cardiovasc Disord. 2011;11:32.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, et al. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008;94(11):1386–93.

    Article  CAS  PubMed  Google Scholar 

  19. von Ballmoos MW, Haring B, Juillerat P, Alkadhi H. Meta-analysis: diagnostic performance of low-radiation-dose coronary computed tomography angiography. Ann Intern Med. 2011;154(6):413–20.

    Article  Google Scholar 

  20. Arbab-Zadeh A, Miller JM, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, et al. Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study. J Am Coll Cardiol. 2012;59(4):379–87.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008;52(25):2135–44.

    Article  PubMed  Google Scholar 

  22. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52(21):1724–32.

    Article  PubMed  Google Scholar 

  23. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359(22):2324–36.

    Article  CAS  PubMed  Google Scholar 

  24. Schuetz GM, Zacharopoulou NM, Schlattmann P, Dewey M. Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. Ann Intern Med. 2010;152(3):167–77.

    Article  PubMed  Google Scholar 

  25. Nielsen LH, Ortner N, Norgaard BL, Achenbach S, Leipsic J, Abdulla J. The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2014;15(9):961–71. Meta-analysis comparing the sensitivity, specificity of CCTA againt functional testings, showing the superiority of CCTA for diagnosis of CAD in comparison with stress testings.

    Article  PubMed  Google Scholar 

  26. Di Carli MF, Arbab-Zadeh A, George RT, Chen MY, Kofoed KF, Dewey M, et al. Comparative effectiveness of myocardial perfusion SPECT and coronary CT angiography for diagnosis of coronary artery disease. J Am Coll Cardiol. 61[10]. 2013. Very important multicenter study, directly comparing the accuracy of CCTA vs. SPECT or diagnosis of CAD, releaving the significantly greater accuracy in CCTA than SPECT.

  27. Linde JJ, Kofoed KF, Sorgaard M, Kelbaek H, Jensen GB, Nielsen WB, et al. Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain: results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH). Int J Cardiol. 2013;168(6):5257–62.

    Article  PubMed  Google Scholar 

  28. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet. 2015. Large multicenter study, evaluating the application of CCTA for the diagnosis of CAD vs. standard of care. CCTA resulted in a better reclassification of CAD than standard of care.

  29. Hamirani YS, Isma'eel H, Larijani V, Drury P, Lim W, Bevinal M, et al. The diagnostic accuracy of 64-detector cardiac computed tomography compared with stress nuclear imaging in patients undergoing invasive cardiac catheterization. J Comput Assist Tomogr. 2010;34(5):645–51.

    Article  PubMed  Google Scholar 

  30. Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, Lamb HJ, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol. 2006;48(12):2508–14.

    Article  PubMed  Google Scholar 

  31. Ravipati G, Aronow WS, Lai H, Shao J, DeLuca AJ, Weiss MB, et al. Comparison of sensitivity, specificity, positive predictive value, and negative predictive value of stress testing versus 64-multislice coronary computed tomography angiography in predicting obstructive coronary artery disease diagnosed by coronary angiography. Am J Cardiol. 2008;101(6):774–5.

    Article  PubMed  Google Scholar 

  32. Tandon V, Hall D, Yam Y, Al-Shehri H, Chen L, Tandon K, et al. Rates of downstream invasive coronary angiography and revascularization: computed tomographic coronary angiography vs. Tc-99m single photon emission computed tomography. Eur Heart J. 2012;33(6):776–82.

    Article  CAS  PubMed  Google Scholar 

  33. Mollet NR, Cademartiri F, Van MC, Meijboom B, Pugliese F, Runza G, et al. Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris. Eur Heart J. 2007;28(15):1872–8.

    Article  PubMed  Google Scholar 

  34. Dewey M, Dubel HP, Schink T, Baumann G, Hamm B. Head-to-head comparison of multislice computed tomography and exercise electrocardiography for diagnosis of coronary artery disease. Eur Heart J. 2007;28(20):2485–90.

    Article  PubMed  Google Scholar 

  35. Nieman K, Galema T, Weustink A, Neefjes L, Moelker A, Musters P, et al. Computed tomography versus exercise electrocardiography in patients with stable chest complaints: real-world experiences from a fast-track chest pain clinic. Heart. 2009;95(20):1669–75.

    Article  CAS  PubMed  Google Scholar 

  36. Ovrehus KA, Jensen JK, Mickley HF, Munkholm H, Bottcher M, Botker HE, et al. Comparison of usefulness of exercise testing versus coronary computed tomographic angiography for evaluation of patients suspected of having coronary artery disease. Am J Cardiol. 2010;105(6):773–9.

    Article  PubMed  Google Scholar 

  37. Maffei E, Seitun S, Martini C, Palumbo A, Tarantini G, Berti E, et al. CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease. Heart. 2010;96(24):1973–9.

    Article  PubMed  Google Scholar 

  38. Navare SM, Mather JF, Shaw LJ, Fowler MS, Heller GV. Comparison of risk stratification with pharmacologic and exercise stress myocardial perfusion imaging: a meta-analysis. J Nucl Cardiol. 2004;11(5):551–61.

    Article  PubMed  Google Scholar 

  39. Poornima IG, Miller TD, Christian TF, Hodge DO, Bailey KR, Gibbons RJ. Utility of myocardial perfusion imaging in patients with low-risk treadmill scores. J Am Coll Cardiol. 2004;43(2):194–9.

    Article  PubMed  Google Scholar 

  40. Fine NM, Pellikka PA, Scott CG, Gharacholou SM, McCully RB. Characteristics and outcomes of patients who achieve high workload (>/=10 metabolic equivalents) during treadmill exercise echocardiography. Mayo Clin Proc. 2013;88(12):1408–19.

    Article  PubMed  Google Scholar 

  41. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283–91.

    Article  PubMed  Google Scholar 

  42. Shaw LJ, Weintraub WS, Maron DJ, Hartigan PM, Hachamovitch R, Min JK, et al. Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention. Am Heart J. 2012;164(2):243–50.

    Article  PubMed  Google Scholar 

  43. Shaw LJ, Cerqueira MD, Brooks MM, Althouse AD, Sansing VV, Beller GA, et al. Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. J Nucl Cardiol. 2012;19(4):658–69.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Panza JA, Holly TA, Asch FM, She L, Pellikka PA, Velazquez EJ, et al. Inducible myocardial ischemia and outcomes in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol. 2013;61(18):1860–70.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Young LH, Wackers FJ, Chyun DA, Davey JA, Barrett EJ, Taillefer R, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA. 2009;301(15):1547–55.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Habib PJ, Green J, Butterfield RC, Kuntz GM, Murthy R, Kraemer DF, et al. Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography: a systematic review and meta-analysis. Int J Cardiol. 2013;169(2):112–20. This important meta-analysis with consisting 82,000 patients and more than 2,000 hard event demonstrated the robust association between cardiac death or MI, all-cause mortality and composite MACE, and the presence and severity of CAD determined by CCTA.

    Article  PubMed  Google Scholar 

  47. Budoff MJ, Liu S, Chow D, Flores F, Hsieh B, Gebow D, et al. Coronary CT angiography versus standard of care strategies to evaluate patients with potential coronary artery disease; effect on long term clinical outcomes. Atherosclerosis. 2014;237(2):494–8.

    Article  CAS  PubMed  Google Scholar 

  48. Al-Mallah MH, Qureshi W, Pantelic M, Nour K. Long term prognostic value of coronary computed tomography angiography in suspected coronary artery disease: a 62 month median follow-up study. Int J Cardiol. 2014;176(3):1244–6.

    Article  PubMed  Google Scholar 

  49. Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol. 2011;58(8):849–60.

    Article  PubMed  Google Scholar 

  50. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol. 2009;53(7):623–32.

    Article  PubMed  Google Scholar 

  51. Shaw LJ, Berman DS, Hendel RC, Borges NS, Min JK, Callister TQ. Prognosis by coronary computed tomographic angiography: matched comparison with myocardial perfusion single-photon emission computed tomography. J Cardiovasc Comput Tomogr. 2008;2(2):93–101.

    Article  PubMed  Google Scholar 

  52. Hlatky MA, Shilane D, Hachamovitch R, Dicarli MF. Economic outcomes in the Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease registry: the SPARC Study. J Am Coll Cardiol. 2014;63(10):1002–8.

    Article  PubMed  Google Scholar 

  53. Shreibati JB, Baker LC, Hlatky MA. Association of coronary CT angiography or stress testing with subsequent utilization and spending among Medicare beneficiaries. JAMA. 2011;306(19):2128–36.

    Article  CAS  PubMed  Google Scholar 

  54. Nielsen LH, Ortner N, Abdulla J. Abstract 12801: Coronary computed tomography angiography versus conventional functionally testing in patients with stable angina pectoris—a systematic review and meta-analysis of diagnostic test performance and post-test outcomes. Circulation 2013;128[2013].

  55. Peteiro J, Monserrrat L, Pineiro M, Calvino R, Vazquez JM, Marinas J, et al. Comparison of exercise echocardiography and the Duke treadmill score for risk stratification in patients with known or suspected coronary artery disease and normal resting electrocardiogram. Am Heart J. 2006;151(6):1324.e1–10.

    Article  Google Scholar 

  56. Elhendy A, Mahoney DW, Khandheria BK, Paterick TE, Burger KN, Pellikka PA. Prognostic significance of the location of wall motion abnormalities during exercise echocardiography. J Am Coll Cardiol. 2002;40(9):1623–9.

    Article  PubMed  Google Scholar 

  57. Bangalore S, Yao SS, Chaudhry FA. Prediction of myocardial infarction versus cardiac death by stress echocardiography. J Am Soc Echocardiogr. 2009;22(3):261–7.

    Article  PubMed  Google Scholar 

  58. Bittencourt MS, Hulten E, Ghoshhajra B, O'Leary D, Christman MP, Montana P, et al. Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging. 2014;7(2):282–91.

    Article  PubMed  Google Scholar 

  59. Hachamovitch R, Nutter B, Hlatky MA, Shaw LJ, Ridner ML, Dorbala S, et al. Patient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease). J Am Coll Cardiol. 2012;59(5):462–74.

    Article  PubMed  Google Scholar 

  60. Min JK, Shaw LJ, Berman DS, Gilmore A, Kang N. Costs and clinical outcomes in individuals without known coronary artery disease undergoing coronary computed tomographic angiography from an analysis of Medicare category III transaction codes. Am J Cardiol. 2008;102(6):672–8.

    Article  PubMed  Google Scholar 

  61. Min JK, Koduru S, Dunning AM, Cole JH, Hines JL, Greenwell D, et al. Coronary CT angiography versus myocardial perfusion imaging for near-term quality of life, cost and radiation exposure: a prospective multicenter randomized pilot trial. J Cardiovasc Comput Tomogr. 2012;6(4):274–83.

    Article  PubMed  Google Scholar 

  62. Nielsen LH, Olsen J, Markenvard J, Jensen JM, Norgaard BL. Effects on costs of frontline diagnostic evaluation in patients suspected of angina: coronary computed tomography angiography vs. conventional ischaemia testing. Eur Heart J Cardiovasc Imaging. 2013;14(5):449–55.

    Article  PubMed  Google Scholar 

  63. Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, et al. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease. N Engl J Med. 2015. Important clinical study which randomized more than 10,000 patients with suspected CAD to a strategy using CCTA vs. functional testing revealing equipoise for outcome of MACE but with trends favoring CCTA.

  64. Nielsen LH, Markenvard J, Jensen JM, Mickley H, Ovrehus KA, Norgaard BL. Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing. Int J Cardiovasc Imaging. 2011;27(6):813–23.

    Article  PubMed  Google Scholar 

  65. Min JK, Kang N, Shaw LJ, Devereux RB, Robinson M, Lin F, et al. Costs and clinical outcomes after coronary multidetector CT angiography in patients without known coronary artery disease: comparison to myocardial perfusion SPECT. Radiology. 2008;249(1):62–70.

    Article  PubMed  Google Scholar 

  66. Hulten E, Goehler A, Bittencourt MS, Bamberg F, Schlett CL, Truong QA, et al. Cost and resource utilization associated with use of computed tomography to evaluate chest pain in the emergency department: the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) study. Circ Cardiovasc Qual Outcomes. 2013;6(5):514–24.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Shreibati JB, Baker LC, Hlatky MA. Association of coronary CT angiography or stress testing with subsequent utilization and spending among Medicare beneficiaries. JAMA. 2011;306(19):2128–36.

    Article  CAS  PubMed  Google Scholar 

  68. DePuey EG. Advances in SPECT camera software and hardware: currently available and new on the horizon. J Nucl Cardiol. 2012;19(3):551–81.

    Article  PubMed  Google Scholar 

  69. Gambhir SS, Berman DS, Ziffer J, Nagler M, Sandler M, Patton J, et al. A novel high-sensitivity rapid-acquisition single-photon cardiac imaging camera. J Nucl Med. 2009;50(4):635–43.

    Article  PubMed  Google Scholar 

  70. Einstein AJ, Blankstein R, Andrews H, Fish M, Padgett R, Hayes SW, et al. Comparison of image quality, myocardial perfusion, and left ventricular function between standard imaging and single-injection ultra-low-dose imaging using a high-efficiency SPECT camera: the MILLISIEVERT study. J Nucl Med. 2014;55(9):1430–7.

    Article  CAS  PubMed  Google Scholar 

  71. Oddstig J, Hedeer F, Jogi J, Carlsson M, Hindorf C, Engblom H. Reduced administered activity, reduced acquisition time, and preserved image quality for the new CZT camera. J Nucl Cardiol. 2013;20(1):38–44.

    Article  PubMed  Google Scholar 

  72. Ficaro EP, Fessler JA, Shreve PD, Kritzman JN, Rose PA, Corbett JR. Simultaneous transmission/emission myocardial perfusion tomography. Diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission computed tomography. Circulation. 1996;93(3):463–73.

    Article  CAS  PubMed  Google Scholar 

  73. Venero CV, Heller GV, Bateman TM, McGhie AI, Ahlberg AW, Katten D, et al. A multicenter evaluation of a new post-processing method with depth-dependent collimator resolution applied to full-time and half-time acquisitions without and with simultaneously acquired attenuation correction. J Nucl Cardiol. 2009;16(5):714–25.

    Article  PubMed  Google Scholar 

  74. Stehli J, Fuchs TA, Bull S, Clerc OF, Possner M, Buechel RR, et al. Accuracy of coronary CT angiography using a submillisievert fraction of radiation exposure: comparison with invasive coronary angiography. J Am Coll Cardiol. 2014;64(8):772–80.

    Article  PubMed  Google Scholar 

  75. George RT, Arbab-Zadeh A, Miller JM, Kitagawa K, Chang HJ, Bluemke DA, et al. Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging. 2009;2(3):174–82.

    Article  PubMed Central  PubMed  Google Scholar 

  76. George RT, Arbab-Zadeh A, Miller JM, Vavere AL, Bengel FM, Lardo AC, et al. Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging. 2012;5(3):333–40.

    Article  PubMed  Google Scholar 

  77. Ko BS, Cameron JD, Meredith IT, Leung M, Antonis PR, Nasis A, et al. Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J. 2012;33(1):67–77.

    Article  PubMed  Google Scholar 

  78. George RT, Mehra VC, Chen MY, Kitagawa K, Arbab-Zadeh A, Miller JM, et al. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study. Radiology. 2014;272(2):407–16.

    Article  PubMed Central  PubMed  Google Scholar 

  79. Rochitte CE, George RT, Chen MY, Arbab-Zadeh A, Dewey M, Miller JM, et al. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J. 2014;35(17):1120–30.

    Article  PubMed  Google Scholar 

  80. Kim HJ, Vignon-Clementel IE, Coogan JS, Figueroa CA, Jansen KE, Taylor CA. Patient-specific modeling of blood flow and pressure in human coronary arteries. Ann Biomed Eng. 2010;38(10):3195–209.

    Article  CAS  PubMed  Google Scholar 

  81. Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011;58(19):1989–97.

    Article  PubMed  Google Scholar 

  82. Min JK, Berman DS, Budoff MJ, Jaffer FA, Leipsic J, Leon MB, et al. Rationale and design of the DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic AngiOgraphy) study. J Cardiovasc Comput Tomogr. 2011;5(5):301–9.

    Article  PubMed  Google Scholar 

  83. Norgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63(12):1145–55.

    Article  PubMed  Google Scholar 

  84. Steigner ML, Mitsouras D, Whitmore AG, Otero HJ, Wang C, Buckley O, et al. Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc Imaging. 2010;3(2):179–86.

    Article  PubMed Central  PubMed  Google Scholar 

  85. Wong DT, Ko BS, Cameron JD, Nerlekar N, Leung MC, Malaiapan Y, et al. Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: a comparison with fractional flow reserve. J Am Coll Cardiol. 2013;61(12):1271–9.

    Article  PubMed  Google Scholar 

  86. Tonino PA, De BB, Pijls NH, Siebert U, Ikeno F, Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213–24.

    Article  CAS  PubMed  Google Scholar 

  87. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60(24):e44–164.

    Article  PubMed  Google Scholar 

  88. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749–67.

    Article  PubMed  Google Scholar 

  89. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003.

    Article  PubMed  Google Scholar 

  90. Arbab-Zadeh A. Fractional flow reserve-guided percutaneous coronary intervention is not a valid concept. Circulation. 2014;129(18):1871–8.

    Article  PubMed Central  PubMed  Google Scholar 

  91. Arbab-Zadeh A, Fuster V. The myth of the “vulnerable plaque”: transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment. J Am Coll Cardiol. 2015;65(8):846–55.

    Article  PubMed  Google Scholar 

  92. Chow BJ, Small G, Yam Y, Chen L, McPherson R, Achenbach S, et al. Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter Registry) registry. Arterioscler Thromb Vasc Biol. 2015;35(4):981–9. This study, demostrated the importance of nonobstructive CAD for predicting mortality in a large clinical registry.

    Article  CAS  PubMed  Google Scholar 

  93. Maddox TM, Stanislawski MA, Grunwald GK, Bradley SM, Ho PM, Tsai TT, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA. 2014;312(17):1754–63. Using a large VA database, this study demonstrates similar rates of myocardial infarction and death among patients with multivessel nonobstructive disease compared to patients with obstructive disease.

    Article  CAS  PubMed  Google Scholar 

  94. Mushtaq S, De Araujo GP, Garcia-Garcia HM, Pontone G, Bartorelli AL, Bertella E, et al. Long-term prognostic effect of coronary atherosclerotic burden: validation of the computed tomography-Leaman score. Circ Cardiovasc Imaging. 2015;8(2), e002332.

    Article  PubMed  Google Scholar 

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AA Rahsepar and A Arbab-Zadeh both declare no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Medicine/Cardiology Division, The Johns Hopkins Hospital, 600 N. Wolfe St/Halsted 559, Baltimore, MD, 21287-0409, USA

    Amir Ali Rahsepar & Armin Arbab-Zadeh

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  1. Amir Ali Rahsepar
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  2. Armin Arbab-Zadeh
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Correspondence to Armin Arbab-Zadeh.

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This article is part of the Topical Collection on Cardiac Computed Tomography

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Rahsepar, A.A., Arbab-Zadeh, A. Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations. Curr Cardiovasc Imaging Rep 8, 29 (2015). https://doi.org/10.1007/s12410-015-9344-y

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