JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases

Q: What is the clinical evidence from this study?

Population: Chronic coronary heart disease. Intervention: Diagnostic testing modalities (Exercise ECG, Holter ECG, echocardiography, CT, MRI, nuclear imaging, intravascular imaging). Primary outcome: Diagnosis and risk assessment of chronic coronary heart disease.

Q: What does this research mean for the field?

Exercise electrocardiography is a recommended Class I (Level of Evidence B) diagnostic tool for chronic coronary heart disease, demonstrating approximately 70-75% sensitivity and specificity. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Masakazu Yamagishi; Nagara Tamaki; Takashi Akasaka; Takanori Ikeda; Kenji Ueshima; Shiro Uemura; Yutaka Otsuji; Yasuki Kihara; Kazuo Kimura; Takeshi Kimura; Yoshiki Kusama; Shin‐ichiro Kumita; Hajime Sakuma; Masahiro Jinzaki; Hiroyuki Daida; Yasuchika Takeishi; Hiroshi Tada; Taishiro Chikamori; Kenichi Tsujita; Kunihiko Teraoka; Kenichi Nakajima; Tomoaki Nakata; Satoshi Nakatani; Akihiko Nogami; Koichi Node; Atsushi Nohara; Atsushi Hirayama; Nobusada Funabashi; Masaru Miura; Teruhito Mochizuki; Hiroyoshi Yokoi; Kunihiro Yoshioka; Masafumi Watanabe; Toshihiko Asanuma; Yuichi Ishikawa; Takahiro Ohara; Koichi Kaikita; Tokuo Kasai; Eri Toda Kato; Hiroshi Kamiyama; Masa‐aki Kawashiri; Keisuke Kiso; Kakuya Kitagawa; Teruhito Kido; Toshio Kinoshita; Tomonari Kiriyama; Teruyoshi Kume; Akira Kurata; Satoshi Kurisu; Masami Kosuge; Eitaro Kodani; Akira Sato; Yasutsugu Shiono; Hiroki Shiomi; Junichi Taki; Masaaki Takeuchi; Atsushi Tanaka; Nobuhiro Tanaka; Ryoichi Tanaka; Takuya Nakahashi; Takehiro Nakahara; Akihiro Nomura; Akiyoshi Hashimoto; Kenshi Hayashi; Masahiro Higashi; Takafumi Hiro; Daisuke Fukamachi; Hitoshi Matsuo; Naoya Matsumoto; Katsumi Miyauchi; Masao Miyagawa; Yoshitake Yamada; Keiichiro Yoshinaga; Hideki Wada; Tetsu Watanabe; Yukio Ozaki; Shun Kohsaka; Wataru Shimizu; Satoshi Yasuda; Hideaki Yoshino

doi:10.1253/circj.cj-19-1131

February 15, 2021Circulation JournalOpen Access

JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases

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Why the study?

Remarkable advances in noninvasive and intravascular diagnostic techniques over the past decade required updating previous guidelines to assist clinicians in selecting tests, diagnosing chronic coronary heart disease, and evaluating risk.

Structured PICO

P

Population

Japanese clinical practice guideline for patients with suspected or known chronic coronary heart disease undergoing diagnostic evaluation and risk assessment.

I

Intervention

Noninvasive and invasive diagnostic modalities (including exercise ECG, Holter ECG, echocardiography, cardiac CT, MRI, nuclear cardiology, and intravascular imaging)

O

Outcome

Diagnostic accuracy (sensitivity and specificity), pretest probability assessment, and prognostic risk stratification for chronic coronary heart disease

Limitations

Difficult to establish direct evidence linking diagnostic tests to clinical outcomes
Exercise ECG sensitivity and specificity are not necessarily high, requiring additional testing in high-risk patients with negative results or low-risk patients with positive results
Holter ECG has limited leads and makes it difficult to assess the exact site or severity of ischemia
It can be difficult to establish evidence for relationships between each diagnostic test and clinical outcomes.
Sensitivity and specificity of exercise ECG are not necessarily high.
Holter ECG provides a limited amount of information due to the small number of leads and makes it difficult to assess the site or severity of ischemia.

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Answers are grounded in this paper and cite their sources.

Implication

This JCS 2018 guideline provides comprehensive, evidence-based recommendations for selecting and interpreting noninvasive and invasive diagnostic tests in patients with chronic coronary heart disease.

Abstract

Recommendations and Levels of Evidence •••••••••••• 404 Pretest Probability and Cardiovascular Risk •••••••••• 405 I. Significance of Various Tests for Diagnosis of Chronic Coronary Heart Disease ••••••••••••••••••••••• 405PAD peripheral arterial disease PCI percutaneous coronary intervention PESP postextrasystolic potentiation PET positron emission tomography PFR peak filling rate QCA quantitative coronary angiography QOL quality of life RCT randomized controlled trial SAE signal-averaged ECG SPECT single photon emission computed tomography TCFA thin-cap fibroatheroma TBI toe-brachial index Tc technetium TOF time-of-flight TPF time-to-peak filling TWA T-wave alternans COR LOE GOR (MINDS) LOE (MINDS) Diagnostic purpose of chronic coronary heart diseases I B C1 IVb COR, class of recommendation; GOR, grade of recommendation; LOE, level of evidence.III C C2 VI Repeated evaluation of cardiac function by echocardiography is not recommended for patients without any changes in clinical status, for whom no change in therapy is planned, and with low risk for cardiovascular events *See Table 55 III C C2 VI COR, class of recommendation; GOR, grade of recommendation; LOE, level of evidence.

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Cite This Study

Yamagishi et al. (2021) studied Chronic coronary heart disease. Diagnostic testing modalities (Exercise ECG, Holter ECG, echocardiography, CT, MRI, nuclear imaging, intravascular imaging) was evaluated on Diagnosis and risk assessment of chronic coronary heart disease. Exercise ECG is recommended as a Class I (Level of Evidence B) diagnostic test for chronic coronary heart disease, demonstrating an approximate sensitivity of 75% and specificity of 70%.

synapsesocial.com/papers/6acda7107d7d8d43ad4a4d6c https://doi.org/10.1253/circj.cj-19-1131

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JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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