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 People who have coronary artery disease ruled out by the scan
benefit, and so do those with severe blockages diagnosed, while
those who have moderate artery disease confirmed may only become
more anxious after the scan, researchers found.
Computed tomography coronary angiography (CTCA), is a
high-resolution X-ray of the heart that can be used to diagnose the
reason for angina, or chest pain, symptoms and clarify what other
treatments might be needed.
“Patients with normal coronary arteries or those with severe
coronary artery disease seemed to get the most benefit in quality of
life and did best,” senior study author Dr. David E. Newby from
University/BHF Center for Cardiovascular Science in Edinburgh, told
Reuters Health.
“This suggests that being reassured that all is normal is highly
valued by patients and CTCA really helps provide this reassurance.
Conversely, knowing the cause of your symptoms is due to coronary
heart disease and patients undergo treatment for it, is also very
helpful,” he said by email.
Although getting CTCA is associated with a lower likelihood of
having a heart attack later on, its effects on symptoms and quality
of life may vary, the researchers note in the journal Heart.
Newby and his team assessed how CTCA affected symptoms and quality
of life six weeks and six months after the scan for 4,146 patients
with suspected angina due to coronary heart disease.
When the CTCA results revealed something less than a blockage,
so-called nonobstructive disease, as the cause for the patient's
chest pain, patients’ quality of life got worse in the following
weeks and months.
This reflects the fact that the cause of the symptoms had been
unknown before and in addition they now have heart artery disease
that needs treatment, Newby said.
The findings were similar when it came to changes in symptoms during
follow-up. Improvements in symptoms were greatest in patients
diagnosed with normal coronary arteries or who had their medications
discontinued and least in those with moderate nonobstructive disease
or who received new prescriptions.
“Although CTCA removes diagnostic uncertainty and halves the rate of
subsequent heart attacks, quality of life can be negatively impacted
in those who are worried about their health and are found to have
nonobstructive coronary artery disease,” Newby said. “Much like
screening tests for cancer, being told you have heart disease does
not make the patient feel better,” he added.
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If a doctor is faced with a patient who is already on an aspirin and
statin with an unconfirmed and questionable clinical diagnosis of
angina due to coronary heart disease, he said, then CTCA would be
useful because finding normal heart anatomy means that more invasive
testing can be avoided, treatment could be stopped and quality of
life improved.
“If, however, a patient presents with atypical symptoms and is on no
therapy, then the clinician needs to discuss with the patient the
implications of potential CTCA findings, including nonobstructive
disease that would mandate life-long preventative therapy,” Newby
said. “Certainly, this is something we now discuss in more detail
with our patients, some of whom have declined CTCA.”
“It was striking for me that health status was very much related to
receiving a (treatable) diagnosis or excluding such a diagnosis,
rather than experiencing angina symptoms per se,” said Dr. Paula M.
C. Mommersteeg from the Center of Research on Psychology in Somatic
Diseases, Tilburg University, The Netherlands, who has investigated
associations between personality traits and coronary artery disease
symptoms.
“In my opinion, CTCA does have added value in the diagnostic process
(improved decision making), it is less invasive than coronary
angiography (CAG), and can provide more clarity in the cardiac
symptoms experienced by patients,” Mommersteeg concluded.
SOURCE: http://bit.ly/2lEdxAV Heart, online February 28, 2017.
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