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Cardiac
Diagnosis
Coronary Artery Disease
Coronary Artery Stenosis
Coronary Artery Stenosis
Stephan Achenbach, MD, FESC, FACC, FSCCT
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Fixed obstructive coronary artery disease (CAD)
              • Often termed stable CAD
              • Sometimes referred to as chronic coronary syndrome

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Scholtz JE et al: Technical aspects, interpretation, and body of evidence for coronary computed tomography angiography. Radiol Clin North Am. 57(1):13-23, 2019
                                      2. Zimmermann FM et al: Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions: meta-analysis of individual patient data. Eur Heart J. 40(2):180-6, 2019
                                      3. Hage FG et al: Review of cardiovascular imaging in the Journal of Nuclear Cardiology in 2017. Part 2 of 2: myocardial perfusion imaging. J Nucl Cardiol. 25(4):1390-9, 2018
                                      4. Motwani M et al: Role of cardiovascular magnetic resonance in the management of patients with stable coronary artery disease. Heart. 104(11):888-94, 2018
                                      5. SCOT-HEART Investigators. et al: Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med. 379(10):924-33, 2018
                                      6. Rabbat MG et al: Interpreting results of coronary computed tomography angiography-derived fractional flow reserve in clinical practice. J Cardiovasc Comput Tomogr. 11(5):383-8, 2017
                                      7. Abbara S et al: SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 10(6):435-49, 2016
                                      8. Cury RC et al: CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comput Tomogr. 10(4):269-81, 2016
                                      9. He Y et al: Diagnostic performance of self-navigated whole-heart contrast-enhanced coronary 3-T MR angiography. Radiology. 281(2):401-8, 2016
                                      10. Leipsic J et al: SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 8(5):342-58, 2014
                                      11. Coelho-Filho OR et al: MR myocardial perfusion imaging. Radiology. 266(3):701-15, 2013
                                      12. Pijls NH et al: Functional measurement of coronary stenosis. J Am Coll Cardiol. 59(12):1045-57, 2012
                                      13. Achenbach S: Current clinical applications of cardiac computed tomography. J Cardiovasc Transl Res. 4(4):449-58, 2011
                                      14. Beller GA et al: SPECT imaging for detecting coronary artery disease and determining prognosis by noninvasive assessment of myocardial perfusion and myocardial viability. J Cardiovasc Transl Res. 4(4):416-24, 2011
                                      15. Halliburton SS et al: SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 5(4):198-224, 2011
                                      16. Sakuma H: Coronary CT versus MR angiography: the role of MR angiography. Radiology. 258(2):340-9, 2011
                                      17. Bengel FM et al: Cardiac positron emission tomography. J Am Coll Cardiol. 54(1):1-15, 2009
                                      18. Raff GL et al: SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 3(2):122-36, 2009
                                      19. Fraker TD Jr et al: 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 50(23):2264-74, 2007. Erratum in: J Am Coll Cardiol. 50(23):e1, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Definitions

                                                • Fixed obstructive coronary artery disease (CAD)
                                                  • Often termed stable CAD
                                                  • Sometimes referred to as chronic coronary syndrome

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Echocardiographic Findings

                                                        • Angiographic Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Scholtz JE et al: Technical aspects, interpretation, and body of evidence for coronary computed tomography angiography. Radiol Clin North Am. 57(1):13-23, 2019
                                                                          2. Zimmermann FM et al: Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions: meta-analysis of individual patient data. Eur Heart J. 40(2):180-6, 2019
                                                                          3. Hage FG et al: Review of cardiovascular imaging in the Journal of Nuclear Cardiology in 2017. Part 2 of 2: myocardial perfusion imaging. J Nucl Cardiol. 25(4):1390-9, 2018
                                                                          4. Motwani M et al: Role of cardiovascular magnetic resonance in the management of patients with stable coronary artery disease. Heart. 104(11):888-94, 2018
                                                                          5. SCOT-HEART Investigators. et al: Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med. 379(10):924-33, 2018
                                                                          6. Rabbat MG et al: Interpreting results of coronary computed tomography angiography-derived fractional flow reserve in clinical practice. J Cardiovasc Comput Tomogr. 11(5):383-8, 2017
                                                                          7. Abbara S et al: SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 10(6):435-49, 2016
                                                                          8. Cury RC et al: CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comput Tomogr. 10(4):269-81, 2016
                                                                          9. He Y et al: Diagnostic performance of self-navigated whole-heart contrast-enhanced coronary 3-T MR angiography. Radiology. 281(2):401-8, 2016
                                                                          10. Leipsic J et al: SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 8(5):342-58, 2014
                                                                          11. Coelho-Filho OR et al: MR myocardial perfusion imaging. Radiology. 266(3):701-15, 2013
                                                                          12. Pijls NH et al: Functional measurement of coronary stenosis. J Am Coll Cardiol. 59(12):1045-57, 2012
                                                                          13. Achenbach S: Current clinical applications of cardiac computed tomography. J Cardiovasc Transl Res. 4(4):449-58, 2011
                                                                          14. Beller GA et al: SPECT imaging for detecting coronary artery disease and determining prognosis by noninvasive assessment of myocardial perfusion and myocardial viability. J Cardiovasc Transl Res. 4(4):416-24, 2011
                                                                          15. Halliburton SS et al: SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr. 5(4):198-224, 2011
                                                                          16. Sakuma H: Coronary CT versus MR angiography: the role of MR angiography. Radiology. 258(2):340-9, 2011
                                                                          17. Bengel FM et al: Cardiac positron emission tomography. J Am Coll Cardiol. 54(1):1-15, 2009
                                                                          18. Raff GL et al: SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 3(2):122-36, 2009
                                                                          19. Fraker TD Jr et al: 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 50(23):2264-74, 2007. Erratum in: J Am Coll Cardiol. 50(23):e1, 2007