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Chest Pain / Angina Pectoris: Difference between revisions
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==Stress Testing in Combination with Imaging== | ==Stress Testing in Combination with Imaging== | ||
Some patients are unable to perform physical exercise. Furthermore, in patients with resting ECG abnormalities the exercise ECG is associated with low sensitivity and specificity. If the ECG made during exercise testing does not show any abnormalities myocardial ischemia becomes unlikely as cause of the complaints. If the diagnosis is still in doubt, the following additional tests may be performed. | Some patients are unable to perform physical exercise. Furthermore, in patients with resting ECG abnormalities the exercise ECG is associated with low sensitivity and specificity. | ||
{| class="wikitable" border="1" width="600px" | |||
|- | |||
|colspan = "7" | <b>Table 4. Characteristics of tests commonly used to diagnose the presence of coronary artery disease<Cite>REFNAME20</Cite></b> | |||
|- | |||
| bgcolor="#FFFFFF" rowspan="2"| | |||
|align="center" colspan="2" bgcolor="#FFFFFF" | <b>Diagnosis of CAD</b> | |||
|- | |||
| align="center" bgcolor="#FFFFFF" | <b>Sensitivity (%)</b> | |||
| align="center" bgcolor="#FFFFFF" | <b>Specificity (%)</b> | |||
|- | |||
| Exercise ECG<sup>a, 91, 94, 95</sup> | |||
|45–50 | |||
|85–90 | |||
|- | |||
| Exercise stress echocardiography<sup>96</sup> | |||
|80–85 | |||
|80–88 | |||
|- | |||
| Exercise stress SPECT<sup>96-99</sup> | |||
|73–92 | |||
|63–87 | |||
|- | |||
| Dobutamine stress echocardiography<sup>96</sup> | |||
|79–83 | |||
|82–86 | |||
|- | |||
| Dobutamine stress MRI<sup>b,100</sup> | |||
|79–88 | |||
|81–91 | |||
|- | |||
| Vasodilator stress echocardiography<sup>96</sup> | |||
|72–79 | |||
|92–95 | |||
|- | |||
| Vasodilator stress SPECT<sup>96, 99</sup> | |||
|90–91 | |||
|75–84 | |||
|- | |||
| Vasodilator stress MRI<sup>b,98, 100-102</sup> | |||
|67–94 | |||
|61–85 | |||
|- | |||
| Coronary CTA<sup>c,103-105</sup> | |||
|95–99 | |||
|64–83 | |||
|- | |||
| Vasodilator stress PET<sup>97, 99, 106</sup> | |||
|81–97 | |||
|74–91 | |||
|- | |||
|colspan="3"|CAD = coronary artery disease; CTA = computed tomography angiography; ECG = electrocardiogram; MRI = magnetic resonance imaging; PET = positron emission tomography; SPECT = single photon emission computed tomography. | |||
|- | |||
|colspan="3"|<sup>a</sup> Results without/with minimal referral bias. | |||
<sup>b</sup> Results obtained in populations with medium-to-high prevalence of disease without compensation for referral bias. | |||
<sup>c</sup> Results obtained in populations with low-to-medium prevalence of disease. | |||
|} | |||
If the ECG made during exercise testing does not show any abnormalities myocardial ischemia becomes unlikely as cause of the complaints. If the diagnosis is still in doubt, the following additional tests may be performed. | |||
#Exercise echocardiography means that an echocardiography is made before and during different stages up to peak exercise in order to identify wall motion abnormalities. <Cite>REFNAME12</Cite> An alternative is pharmacological stress testing using dobutamine. | #Exercise echocardiography means that an echocardiography is made before and during different stages up to peak exercise in order to identify wall motion abnormalities. <Cite>REFNAME12</Cite> An alternative is pharmacological stress testing using dobutamine. | ||
#Myocardium Perfusion Scintigraphy (MPS) is able to show the perfusion of the heart during exercise and at rest based on radiopharmaceutical tracer uptake . <Cite>REFNAME13</Cite> | #Myocardium Perfusion Scintigraphy (MPS) is able to show the perfusion of the heart during exercise and at rest based on radiopharmaceutical tracer uptake . <Cite>REFNAME13</Cite> | ||