The role of stress echocardiography in the evaluation of coronary artery disease and myocardial ischemia in women

2016 ◽  
Vol 23 (5) ◽  
pp. 1023-1035 ◽  
Author(s):  
Ratnasari Padang ◽  
Patricia A. Pellikka
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Artery Disease

scholarly journals Role of adjuvant carotid ultrasound in women undergoing stress echocardiography for the assessment of suspected coronary artery disease

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001188
Author(s):  
Sothinathan Gurunathan ◽  
Mayooran Shanmuganathan ◽  
Reinette Hampson ◽  
Rajdeep Khattar ◽  
Roxy Senior
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Value ◽  
Carotid Plaque ◽  
Stress Echocardiography ◽  
Risk Scores ◽  
Plaque Burden ◽  
Carotid Ultrasound ◽  
Artery Disease

ObjectiveDue to the low prevalence of obstructive coronary artery disease (CAD) in women, stress testing has a relatively low predictive value for this. Additionally, conventional cardiovascular risk scores underestimate risk in women. This study sought to evaluate the role of atherosclerosis assessment using carotid ultrasound (CU) in women attending for stress echocardiography (SE).MethodsThis was a prospective study in which consecutive women with recent-onset suspected angina, who were referred for clinically indicated SE, underwent CU.Results415 women (mean age 61±10 years, 29% diabetes mellitus, mean body mass index 28) attending for SE underwent CU. 47 women (11%) had inducible wall motion abnormalities, and carotid disease (CD) was present in 46% (carotid plaque in 41%, carotid intima-media thickness >75th percentile in 15%). Women with CD were older (65 vs 58 years, p<0.001), and more likely to have diabetes (41% vs 21%, p=0.001), hypertension (67% vs 36%, p<0.01) and a higher pretest probability of CAD (59% vs 41%, p<0.001). 40% of women classified as low Framingham risk were found to have evidence of CD.The positive predictive value of SE for flow-limiting CAD was 51%, but with the presence of carotid plaque, this was 71% (p<0.01). Carotid plaque (p=0.004) and ischaemia (p=0.01) were the only independent predictors of >70% angiographic stenosis. In women with ischaemia on SE and no carotid plaque, the negative predictive value for flow-limiting disease was 88%.During a follow-up of 1058±234 days, there were 15 events (defined as all-cause mortality, non-fatal myocardial infarction, heart failure admissions and late coronary revascularisation). Age (HR 1.07 (1.00–1.15), p=0.04), carotid plaque burden (HR 1.65 (1.36–2.00), p<0.001) and ischaemic burden (HR 1.41 (1.18–1.68), p<0.001) were associated with outcome. There was a stepwise increase in events/year from 0.3% when there were no ischaemia and atherosclerosis, 1.1% when there was atherosclerosis and no ischaemia, 2.2% when there was ischaemia and no atherosclerosis and 10% when there were both ischaemia and atherosclerosis (p<0.001).ConclusionCU significantly improves the accuracy of SE alone for identifying flow-limiting disease on coronary angiography, and improves risk stratification in women attending for SE, as well identifying a subset of women who may benefit from primary preventative measures.

scholarly journals Myocardial Ischemia During Mental Stress: Role of Coronary Artery Disease Burden and Vasomotion

2013 ◽  
Vol 2 (5) ◽  
Author(s):  
Ronnie Ramadan ◽  
David Sheps ◽  
Fabio Esteves ◽  
A. Maziar Zafari ◽  
J. Douglas Bremner ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Mental Stress ◽  
Disease Burden ◽  
Artery Disease

Treadmill Exercise Testing

2015 ◽  
Author(s):  
Joshua A. Turner ◽  
Todd M. Brown
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Exercise Testing ◽  
Treadmill Exercise ◽  
Prognostic Information ◽  
Performance Interpretation ◽  
Artery Disease ◽  
Treadmill Exercise Testing

Treadmill exercise testing is an important tool in the field of cardiology and is very commonly used because it is readily available, inexpensive, noninvasive, and provides pertinent diagnostic and prognostic information in assessing for the presence and severity of coronary artery disease (CAD). For decades, its primary use was to provoke and diagnose myocardial ischemia, but its clinical indications have become more numerous with time. In this chapter, we will review role of treadmill exercise testing in patients with known or suspected CAD, as well as the contraindications, complications, performance, interpretation, and its prognostics utility.

Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography

2001 ◽  
Vol 40 (06) ◽  
pp. 198-206 ◽  
Author(s):  
M. Jochims ◽  
P. Theissen ◽  
F. M. Baer ◽  
J. Crnac ◽  
E. Voth ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Dobutamine Stress ◽  
Resonance Imaging ◽  
Alternative Strategies ◽  
Artery Disease

SummaryAim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutami-ne-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-seg-ment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modeli. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis >50%.) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. Eor dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.

scholarly journals P327 Concordance between regadenoson stress echocardiography and spect-MIBI (99mTc) in patients with suspected myocardial ischemia

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J C E M Echarte ◽  
P M S Menendez ◽  
I I G Iglesias ◽  
J V M Vara ◽  
J B R Borrego ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Coronary Revascularization ◽  
Kappa Index ◽  
A2a Adenosine Receptor ◽  
Adenosine Receptor Agonist ◽  
Risk Stratum ◽  
Artery Disease

Abstract Background Regadenoson is a selective A2A adenosine receptor agonist approved for the detection of myocardial with SPECT-MIBI. To date, few studies have appraised the utility of this drug using transthoracic echocardiography with the same purpose. We designed this prospective study to evaluate the diagnostic agreement between these two techniques used simultaneously to detect myocardial ischemia. We report our first results evaluating the concordance between both techniques. Methods Patients enrolled were referred to our clinic for the evaluation of chest pain. Myocardial perfusion imaging was performed with regadenoson (400 µg ) which was injected before 99mTc-MIBI. Stress and rest sets of images were evaluated for relative uptake of the radiotracer in order to detect and characterize perfusion defects. The echocardiogram was acquired 60-90 seconds after the administration of the drug using a standardized technique. Two independent observers (one cardiologist and one specialist in nuclear medicine) interpreted the images, both unaware of the result of the complementary technique. Results One hundred twenty five patients were included, 69 (55%) of them males. Median age was 73 years (IQR 65-79). One hundred seventeen patients had both studies interpretable. Thirty-nine (32.5%) patients had had a diagnosis of ischemic heart disease before the study (either a myocardial infarction or a coronary revascularization). The median pre-test probability of coronary artery disease in those without a true previous diagnosis was 30.5% (16.0-50.8), being 50% in the intermediate risk (15-85%) and 49% in the low risk stratum (less than 15%). Significant reductions is systolic and diastolic blood pressure were detected with regadenoson [systolic 134 (21) mmHg Vs 131 (23) mmHg, p &lt; 0.001; diastolic: 78 (12) mmHg Vs 73 (13) mmHg, p &lt; 0.001], with a striking increase in heart rate: 67 (13) bpm Vs 91 (17) bpm, p &lt; 0.001. More patients had a SPECT test showing myocardial ischemia (28% Vs 16%; p &lt; 0.001). Agreement between both tests were 84%. The kappa index obtained from this sample was 0.34 (CI95% 0.15-0.53). Segregating those patients without a history of coronary artery disease (n = 81), the positive test rate were 14% for echo and 20% for SPECT-MIBI (p = 0.019). Kappa index was even lower: 0.29 (CI95% 0.02-0.56). Conclusions. SPECT-MIBI provides more positive tests than stress echocardiography when regadenoson is used as the stressor agent. The concordance between tests is low.

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