Controversies in Diagnostic Imaging of Patients With Suspected Stable and Acute Chest Pain Syndromes

JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 1):1254-1278. doi: 10.1016/j.jcmg.2019.05.009.


There has been a tremendous growth quantity of high-quality imaging evidence in the area of acute and stable ischemic heart disease (SIHD). A number of recent comparative effectiveness trials have spurned significant controversies in the field of cardiovascular imaging. The result of this evidence is that many health care policies and national guidelines have undergone significant revisions. With all of this evidence, many challenges remain and the optimal evaluation strategy for evaluation of patients presenting with chest pain remains ill-defined. This paper enlisted the guidance of numerous experts in the field of cardiovascular imaging to garner their perspective on available imaging research in chest pain syndromes. Each of these vignettes represent editorial perspectives and diverse opinions as to which, if any, should be the primary test in the evaluation of stable chest pain. These perspectives are not meant to be all inclusive but to highlight many of the commonly discussed controversies in the evaluation of chest pain symptoms. These perspectives are presented as a pre-amble to an upcoming American College of Cardiology/American Heart Association clinical practice guideline that is undergoing revision from the previous report published in 2012. The evidence has changed considerably since the 2012 SIHD guideline, and the current perspectives represent the diversity of available evidence as to the optimal imaging strategy for evaluation of the symptomatic patient.

Keywords: anatomy; chest pain; functional testing; imaging.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging*
  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / therapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Angina, Stable / diagnostic imaging*
  • Angina, Stable / epidemiology
  • Angina, Stable / therapy
  • Cardiac Imaging Techniques*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / therapy
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Patient Selection
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Risk Factors