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Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women

Slide: 7 of 23

Background: Using Noninvasive Technologies To Diagnose Coronary Artery Disease (2 of 2)

For patients at intermediate risk for coronary artery disease (CAD) and for patients for whom coronary angiography is contraindicated (patients who are unable to tolerate invasive catheterization or whose vascular disease increases their risk of procedure-related bleeding or blockage), noninvasive technologies (NITs) are an important diagnostic option. There are currently a variety of NITs for clinicians to choose from. The NITs used to diagnose CAD may be categorized as “functional” (can be used to evaluate functional status) or “anatomic” (can be used to visualize anatomic abnormalities) tests.

NITs that assess functional status evaluate coronary circulation at rest and during exercise or pharmacological stress either by looking at patterns of blood flow to the heart muscle (perfusion studies) or at contraction patterns of the left ventricle (echocardiography). Comparison of images at rest and after exercise/stress can reveal areas of ischemia or prior myocardial infarction. NITs that assess functional status include:

  •  Exercise/stress electrocardiography (ECG)
  •  Exercise/stress echocardiography (ECHO)
  • Exercise/stress radionuclide myocardial perfusion imaging (single photon emission computed tomography [SPECT]; positron emission tomography [PET])

Anatomic NITs provide anatomic evaluation of the coronary arteries without the risks associated with invasive angiography. Anatomic NITs help determine the presence of obstructive CAD, nonobstructive CAD, or no CAD. These modalities have to technically match the excellent spatial and temporal resolution offered by coronary angiography. Anatomic NITs currently available for CAD diagnosis include:

  • Cardiac magnetic resonance imaging (CMR)
  • Coronary computed tomography angiography (CTA)

The American Heart Association and the American College of Cardiology recommend that women with suspected CAD should be classified as either symptomatic or asymptomatic and further classified as being at low, intermediate, or high risk for the disease to guide the decision about which diagnostic test to use first.