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Kardiologie up2date 2015; 11(03): 177-187
DOI: 10.1055/s-0034-1393031
Diagnostische Verfahren und Bildgebung
© Georg Thieme Verlag KG Stuttgart · New York

Nicht invasive Ischämiediagnostik – wie ist der Stand seit den ESC-Leitlinien 2013?

Leif-Christopher Engel
,
Costantina Manes
,
Ulf Landmesser
,
Boris Bigalke
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Publikationsverlauf

Publikationsdatum:
28. September 2015 (online)

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Abstract

Coronary artery disease continues to be the leading cause of death in developed countries. As coronary atherosclerosis worsens, luminal narrowing caused by coronary plaque mass may result in haemodynamic obstruction and subsequently, angina pectoris symptoms may occur. To avoid redundant invasive procedures and minimize its complications, noninvasive imaging is often performed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for invasive coronary angiography. The diagnostic accuracy and prognostic value of these strategies have been confirmed in many single-center or multi-center trials. In 2013 the updated ESC guidelines on the management on stable coronary artery disease were released, highlighting the aspect that the diagnostic algorithm is based on the pre-test-probability of coronary artery disease. The consideration of new imaging modalities such as cardiovascular magnetic resonance imaging and coronary CT angiography however, makes it harder for the referring physician to choose the right imaging modality for a patient. This article reviews the clinical utility and the limitations of the most widely used noninvasive imaging modalities and summarizes the diagnostic work-up according to the current ESC guidelines.

Kernaussagen

  • In den aktuellen ESC-Leitlinien zum Management der stabilen KHK wird die nicht invasive Ischämiediagnostik, deren klinische Wertigkeit in vielen Einzel- und Multicenter-Studien gut belegt ist, höher eingestuft als das Belastungs-EKG.

  • Die Wahl eines geeigneten bildgebenden Verfahrens zur Diagnose oder Ausschluss einer KHK richtet sich neben bestimmten Patientencharakteristika nach der lokalen Verfügbarkeit und der ausreichenden Expertise der behandelnden Ärzte, um die Indikation korrekt zu stellen und die Untersuchung mit größtem Nutzen für den Patienten durchzuführen.

  • Im Vergleich zu allen anderen nicht invasiven Ischämietests sind besonders die Stress-Kardio-MRT und die Kardio-CT geeignet, um eine signifikante Koronarstenose zu identifizieren.

 

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