Chest Pain Guidelines

The first comprehensive guideline for the evaluation of chest pain was published in October 2021 by the American Heart Association (AHA) and the American College of Cardiology (ACC) and received the endorsement of most of the other U.S. subspecialty cardiology societies. The new guideline recommends medical professionals use standardized risk assessments, clinical pathways and tools to evaluate and communicate with people experiencing chest pain. While the guideline covers the role of all types of tests and imaging, the new guidelines elevated the frontline use of coronary computed tomography angiography (CCTA) and FFR-CT in specific patients. This inclusion has caused a large amount of interest in expanding cardiac CT programs.

Brian Ghoshhajra, MD, MBA, division chief, cardiovascular imaging, Massachusetts General Hospital and associate professor of radiology, Harvard Medical School, and a board member of the Society of cardiovascular Computed Tomography (SCCT) explains the rapidly expanding interest in cardiac computed tomography (CT) under the new chest pain evaluation guidelines.

VIDEO: The new role of cardiac CT in chest pain evaluation

Brian Ghoshhajra, MD, MBA, division chief, cardiovascular imaging, Massachusetts General Hospital and associate professor of radiology, Harvard Medical School, and a board member of the Society of cardiovascular Computed Tomography (SCCT), explains the rapidly expanding interest in cardiac computed tomography (CT) under the new chest pain evaluation guidelines.

The American Society fo Nuclear Cardiology (ASNC) did not support the 2021 Chest Pain Guidelines because of the high support for cardiac CT and FFR-CT.

VIDEO: Why the ASNC did not support the 2021 Chest Pain Evaluation Guidelines

Randall Thompson, MD, immediate past president of the American Society of Nuclear Cardiology, said the group had issues with the document's elevation of cardiac CT and FFR-CT. 

Cardiac CT imaging has been moved to the forefront of medical imaging to evaluate chest pain under the new 2021 chest pain guidelines from the AHA and ACC. #Yescct #CCTA #CTA #CT

VIDEO: The new role of cardiac CT under the 2021 chest pain evaluation guidelines

Eric Williamson, MD, president of the Society of Cardiovascular Computed Tomography (SCCT) and professor of radiology at Mayo Clinic, explains the rapid rise of interest in cardiac CT imaging following its inclusion as a top recommendation in the ACC 2021 Chest Pain Evaluation Guidelines.

CT-FFR before TAVR improves detection of coronary artery disease, limits invasive imaging exams

CT-FFR, which recently got a boost from the 2021 AHA/ACC chest pain guidelines, could play a key role for clinicians hoping to screen TAVR patients for coronary heart disease. 

An example of CT imaging coronary plaque assessment on TeraRecon's advanced visualization software.

VIDEO: Use of CT to assess coronary plaques

Leslee Shaw, PhD, director of The Blavatnik Family Women’s Health Research Institute, Mount Sinai Hospital, New York, explains how cardiac computed tomography (CT) can be used to assess coronary plaques.

Heartflow FFR-CT allows noninvasive assessment of a patient'c coronary arteries without the need for a diagnostic angiogram.

VIDEO: HeartFlow FFR-CT sees increased interest after inclusion in the 2021 Chest Pain Guidelines

HeartFlow’s non-invasive cardiac computed tomography derived fractional flow reserve (FFR-CT) technology enables FFR values for the entire coronary tree of a patient using just a CT scan. This can show the significance of any coronary plaque lesions and if a patient needs to be sent to the cath lab for revascularization, or if they can be treated medically.

Why cardiologists and radiologists are choosing cardiac CT over invasive angiography for suspected CAD

"A CT-first strategy allows physicians to provide relevant findings without the need for an invasive procedure," one radiologist explained. 

PHOTO GALLERY: Duly Health adopts outpatient cardiac CT as a standard of care

Duly Health and Care in suburban Chicago recently opened a new outpatient cardiac evaluation center equipped with a dedicated cardiac CT system, which will likely be a new business model that will be seen more in the coming years.

Around the web

Several key trends were evident at the Radiological Society of North America 2024 meeting, including new CT and MR technology and evolving adoption of artificial intelligence.

Ron Blankstein, MD, professor of radiology, Harvard Medical School, explains the use of artificial intelligence to detect heart disease in non-cardiac CT exams.