Comparing stress echocardiography and CT coronary angiography for chronic coronary syndrome

Stress Echocardiography With Carotid Ultrasound vs Routine CT Coronary Angiography in Suspected Chronic Coronary Syndrome for the Detection of Obstructive Coronary Disease and Prevention of Adverse Outcomes.

This study is testing whether a combination of stress echocardiography and carotid ultrasound works better than regular CT scans for diagnosing heart problems in adults with chronic coronary syndrome.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 2000 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: London North West Healthcare NHS Trust (Academic / other)
• Locations: 1 site (Harrow, Middx)
• Trial ID: NCT06185530 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to evaluate the effectiveness of stress echocardiography combined with carotid ultrasound compared to routine CT coronary angiography in patients with chronic coronary syndrome. The study will involve patients over 18 years old who are suspected of having coronary artery disease (CAD) and require further imaging investigations. By assessing the severity of coronary disease through these non-invasive tests, the trial seeks to determine which method provides better diagnostic accuracy and patient outcomes.

Who should consider this trial

Good fit: Ideal candidates for this study are adults over 18 years old who have symptoms suggestive of coronary artery disease and require further imaging evaluation.

Not a fit: Patients with a known history of obstructive coronary artery disease or those requiring urgent treatment for acute coronary syndrome may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to improved diagnostic strategies for patients with chronic coronary syndrome, potentially reducing the need for invasive procedures.

How similar studies have performed: Other studies have shown varying success with similar non-invasive imaging approaches, but this specific comparison of stress echocardiography and CTCA is relatively novel.

Eligibility criteria

Inclusion Criteria:

1. Age \> 18 years old
2. Patients referred to RACPC and judged by the reviewer to require a further imaging investigation, either SE or CTCA, to evaluate a suspected diagnosis of CAD
3. AND

   1. Have a PTP score ≥ 5%, as calculated using ESC guidelines OR
   2. Have clinical history in keeping with 'typical' angina symptoms, as judged by the investigator, in patients with a PTP score \<5% - With 'typical' symptoms, as per ESC guidelines, being all three of the following

   i) Constricting symptoms in the front of the chest or in the neck, jaw, shoulder or arm ii) Precipitated by physical exertion iii) Relieved by rest or nitrates within 5 minutes
4. Able to give informed consent to participate in the study and its follow up

Exclusion Criteria:

1. Patients with diagnosed ACS that require urgent or emergency treatment or hospitalisation for inpatient investigations.
2. Known history of obstructive CAD (Previous MI, PCI or CABG) or previous invasive angiography with evidence of ≥ 50% stenosis in any epicardial vessel.
3. Patients who have undergone invasive or non-invasive, functional or anatomical (Including CAC score) testing for detection of CAD within the previous 1 year of clinical assessment.
4. Documented allergy to iodinated contrast or documented allergy to both ultrasound contrasts used at LNWH Trust; Luminity® (Perflutren) and SonoVue® (Sulphur Hexafluoride) or the constitutes
5. Contraindications to undergoing CTCA, including but not limited to;

   * eGFR \< 40 ml/min
   * Contraindications to beta-blockers including but not limited to, documented allergy or significant airways disease in the judgement of the investigator.
   * Exceeding CT scanner weight tolerance
6. Contraindications to undergoing SE, including but not limited to;

   * Known cardiomyopathic process (Hypertrophic cardiomyopathy (HCM)) with resting gradient \> 50mmHg or severe valvular lesion
   * Severe uncontrolled hypertension (≥180/100mmHg)
7. Known pregnancy
8. Unable to provide informed consent

Where this trial is running

Harrow, Middx

• London North West University Healthcare NHS Trust — Harrow, Middx, United Kingdom (Recruiting)

Study contacts

• Principal investigator: Prof Roxy Senior — LNWH Trust
• Study coordinator: Emma Howard

Conditions Chronic Coronary Syndrome; Coronary Disease; Coronary Artery Disease; CTCA; Stress Echocardiography; Carotid Ultrasound