Improvement or worsening of chest pain symptoms and quality of life after a CT scan of the heart may depend on what the scan finds, a large study suggests.
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.
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.
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