Overview of imaging methods used in the diagnosis of stable coronary artery disease

Ischemic heart disease retains its leadership in the structure of morbidity and mortality both in Russia and worldwide. Because of this, the issues of timely diagnosis of coronary artery disease are very relevant. Invasive coronary angiography remains the "gold standard" for assessing the anatomy of the coronary bed, however, not all obstructive coronary artery stenosis are functionally significant and require revascularization. This determines the need for a preliminary assessment of the coronary bed using non-invasive imaging diagnostic methods, which are an alternative to invasive coronary angiography in patients with stable ischemic heart disease. Numerous studies have confirmed the role of computed tomography angiography of the heart in the differential diagnosis of patients with chest pain. Computed tomographic angiography is preferred in patients with the lowest values of the pre-test probability of coronary heart disease, as it has a very high negative prognostic value. The growing availability of software analysis makes computed tomographic angiography of the heart a universal imaging method capable of determining the anatomical and functional significance of stenotic lesions of the coronary arteries, identifying signs of intra- and pericoronary inflammation, and evaluating non-coronary structures. Functional imaging methods (such as stress echocardiography, PET, SPECT, stress MRI) are preferred in patients with a higher pre-test probability of coronary artery disease, as they are designed to detect ischemia and determine indications for revascularization. Choosing the most informative diagnostic method in each specific situation allows you to reduce the frequency of prescribing, increase the validity and effectiveness of invasive coronary angiography and revascularization, thereby increasing the effectiveness of treatment and improving the prognosis. The purpose of this article is to systematize the modern diagnostic approach to the management of patients with stable coronary heart disease with an emphasis on imaging techniques.

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