Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm.
Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm.
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DOI：
10.4081/hi.2012.e2
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发表时间：
2012-02-03
影响因子：
0.2
通讯作者：
Arbab-Zadeh A
中科院分区：
文献类型：
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作者：
Arbab-Zadeh A
冠状动脉疾病的诊断和管理是我们医疗保健系统面临的主要挑战，每年影响数百万患者。直到最近，冠状动脉疾病的诊断只能通过心导管插入术和侵入性冠状动脉造影术。为了避免侵入性手术的风险，压力测试通常用于疑似冠状动脉疾病患者的初步评估，作为心导管插入术的看门人。随着非侵入性冠状动脉造影术的出现，问题出现了，如果这样的策略仍然是明智的，特别是考虑到只有一个温和的协议之间的压力测试结果和心导管检查确定的冠状动脉疾病的存在。在过去的几年里，已经出现了许多支持计算机断层扫描无创冠状动脉造影诊断准确性和预后价值的数据。这些数据挑战了负荷试验作为疑似冠状动脉疾病患者初始成像方式的作用。本文综述了临床实用性，局限性，以及与非侵入性冠状动脉成像的计算机断层扫描相比，负荷试验的危害。最后，这篇评论的影响进行了讨论，在临床实践中。
Diagnosis and management of coronary artery disease represents major challenges to our health care system, affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease was possible only through cardiac catheterization and invasive coronary angiography. To avoid the risks of an invasive procedure, stress testing is often employed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for cardiac catheterization. With the emergence of non-invasive coronary angiography, the question arises if such a strategy is still sensible, particularly, in view of only a modest agreement between stress testing results and the presence of coronary artery disease established by cardiac catheterization. Much data in support of the diagnostic accuracy and prognostic value of non-invasive coronary angiography by computed tomography have emerged within the last few years. These data challenge the role of stress testing as the initial imaging modality in patients with suspected coronary artery disease. This article reviews the clinical utility, limitations, as well as the hazards of stress testing compared with non-invasive coronary artery imaging by computed tomography. Finally, the implications of this review are discussed in relation to clinical practice.