EACVI survey on investigations and imaging modalities in chronic coronary syndromes.
EACVI survey on investigations and imaging modalities in chronic coronary syndromes.
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DOI：
10.1093/ehjci/jeaa300
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发表时间：
2021-01-01
期刊：
影响因子：
--
通讯作者：
Dweck MR
中科院分区：
文献类型：
--
作者：
Bularga A;Saraste A;Fontes-Carvalho R;Holte E;Cameli M;Michalski B;Williams MC;Podlesnikar T;D'Andrea A;Stankovic I;Mills NL;Manka R;Newby DE;Schultz-Menger J;Haugaa KH;Dweck MR
欧洲心血管成像协会（EACVI）科学倡议委员会进行了一项全球调查，以评价疑似和确诊慢性冠状动脉综合征患者的评估和管理的现行做法。来自世界各地37个国家的110个成像中心对调查作出了回应。除心血管磁共振（40%的中心可用）外，大多数冠状动脉疾病的非侵入性检查都是广泛可用的。冠状动脉计算机断层扫描血管造影术（CCTA）和核扫描由一个多学科小组报告，只有四分之一的中心。在对胸痛患者的初步评估中，只有32%的受访者表示他们依赖于预检验概率来选择最佳成像检查，而31%的受访者直接进行CCTA。在确诊冠心病和复发性胸痛的患者中，受访者选择了负荷超声心动图（27%）和核负荷灌注扫描（26%）。在患有冠状动脉疾病和阻塞性（>70%）右冠状动脉狭窄的无症状患者中，58%的受访者愿意在没有进一步检测或干预的情况下寻求药物治疗。这一比例下降到29%与左前降支狭窄和1%与左主干阻塞。在有中度至重度心肌缺血证据的无症状患者中（15%），只有18%的受访者会继续药物治疗而不进行进一步调查。尽管指南建议在少数中心使用预检验概率来评估疑似冠状动脉患者，但三分之一的中心直接转向CCTA。临床医生仍然不愿在症状得到控制但存在阻塞性冠状动脉狭窄或心肌缺血的患者中寻求最佳药物治疗策略，而不进行进一步的调查或干预。
The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate current practice for the assessment and management of patients with suspected and confirmed chronic coronary syndromes. One-hundred and ten imaging centres from 37 countries across the world responded to the survey. Most non-invasive investigations for coronary artery disease were widely available, except cardiovascular magnetic resonance (available 40% centres). Coronary computed tomography angiography (CCTA) and nuclear scans were reported by a multi-disciplinary team in only a quarter of centres. In the initial assessment of patients presenting with chest pain, only 32% of respondents indicated that they rely on pre-test probability for selecting the optimal imaging test while 31% proceed directly to CCTA. In patients with established coronary artery disease and recurrent chest pain, respondents opted for stress echocardiography (27%) and nuclear stress perfusion scans (26%). In asymptomatic patients with coronary artery disease and an obstructive (>70%) right coronary artery stenosis, 58% of respondents were happy to pursue medical therapy without further testing or intervention. This proportion fell to 29% with left anterior descending artery stenosis and 1% with left main stem obstruction. In asymptomatic patients with evidence of moderate-to-severe myocardial ischaemia (15%), only 18% of respondents would continue medical therapy without further investigation. Despite guidelines recommendations pre-test probability is used to assess patients with suspected coronary artery in a minority of centres, one-third of centres moving directly to CCTA. Clinicians remain reticent to pursue a strategy of optimal medical therapy without further investigation or intervention in patients with controlled symptoms but obstructive coronary artery stenoses or myocardial ischaemia.
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