Diagnostic Testing

Question 1

Diagnostic testing for CAD

Answer 1

Can be categorized as

• Functional studies: Reveal the presence of ischemia (exercise ECG, SPECT & PET), extent and severity of ischemia (SPECT, PET), information on coronary blood flow (PET, fractional flow reserve “FFR-CT) and development of wall motion abnormalities (ETT/ETE, CMR).
• Anatomic information: Invasive angiography, coronary CT angiography (CTA) and coronary artery calcium (CAC) scoring

Question 2

Initial diagnostic test in most patients suspected of having CAD

Answer 2

Exercise ECG

Question 3

Diagnostic test for CAD recommended when baseline ECG findings are abnormal (abnormal characteristics) or when information on a particular area of myocardium at risk is needed

Answer 3

Stress echocardiography or nuclear SPECT perfusion

Baseline ECG abnormal (LVH, LBBB, paced rhythm, preexcitacion, >1 mm ST depression)

Question 4

Advantages and limitations of Stress echocardiography

Answer 4

A.
- Acquired along with imaging for wall motion abnormalities to indicate ischemia
- Evaluation of valve function and pulmonary pressures
- Fast and less costly

L.
- Image is suboptimal in some patients
- Interpretation is difficult when baseline wall motion abnormalities are present
- Dx accuracy decreases with single vessel disease

Question 5

Advantages and limitations of nuclear SPECT perfusion

Answer 5

A.
- Allows evaluation of myocardial viability (thallium)

L.
- Attenuation artifacts can be caused by breast tissue or diaphragm interference
- Radiation exposure

Question 6

Mentions the studies covered in
- Exercise stress testing
- Pharmacologic stress testing (recommended in patients who cannot exercise)

Answer 6

• Exercise stress testing
• Exercise ECG
• Stress echocardiography
• Nuclear SPECT perfusion
• Pharmacologic stress testing
• Dobutamine echocardiography
• Vasodilatador nuclear perfusion (adenosine, dipyridamole, regadenoson)
• Dobutamine nuclear perfusion
• PET/CT
• Dobutamine or adenosine CMR imaging
• Other tests
• Coronary angiography
• CAC scoring
• Coronary CT angiography

Question 7

Advantages and limitations of pharmacologic stress testing

Answer 7

• Dobutamine echocardiography
  A: Images acquired continuously / Allow stop the test as soon as ischemia is evident
  L: CONTRAINDICATIONS = Severe HTA, tachyarrhythmias or aortic stenosis, unstable angina, HCM and larg aortic aneurysm
• Vasodilatador nuclear perfusion (adenosine, dipyridamole, regadenoson)
  A: May minimize effect of BB on perfusion defect size / Imaging can be performed sooner after myocardial infarction with VD stress
  L: CONTRAINDICATIONS = Active bronchospastic airway disease, theophylline use, sick sinus syndrome, hypotension and high-degree AV block. /
• Dobutamine nuclear perfusion
  A:
  L:
• PET/CT
  A:
  L:
• Dobutamine or adenosine CMR imaging
  A:
  L: