Should exercise myocardial perfusion imaging be the standard noninvasive approach for the initial evaluation of symptomatic women with suspected coronary artery disease?
نویسندگان
چکیده
Exercise ECG (SECG) is one of several noninvasive test procedures routinely used to diagnose coronary disease presence and to estimate prognosis. Unfortunately, like all current noninvasive procedures used for this type of risk stratification, test accuracy is imperfect. A common approach to improve test sensitivity is to implement an additional modality, such as exercise myocardial perfusion imaging (MPI). However, the additional procedure adds cost, may lead to false-positive results that necessitate downstream testing, and, in the case of MPI, adds radiation exposure ( 11 mSv for rest-stress Tc sestamibi and 29 mSv for dual isotope Tl-Tc sestamibi studies).1,2 Very few studies have examined the cost-effectiveness of using either SECG or MPI as the initial exercise test procedure to assess symptomatic women with suspected coronary disease. Risk stratification with SECG/MPI is considerably more difficult in women than men, in part because of a greater frequency of abnormal SECG, more soft-tissue attenuation on MPI (ie, breast artifacts), and, in general, a lower pretest risk of coronary disease.3 The likelihood of finding obstructive coronary disease in a woman seen for the initial evaluation of stable chest pain is strongly influenced by the character of chest pain (typical angina, atypical angina, nonspecific chest pain), age, and risk factors that are used to estimate the pretest risk of coronary disease and the likelihood of future cardiac events.3,4
منابع مشابه
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عنوان ژورنال:
- Circulation
دوره 124 11 شماره
صفحات -
تاریخ انتشار 2011