Stable ischemic heart disease. Using stress and imaging procedures to direct therapy.
The predictive value of a screening test depends on its accuracy and the pretest likelihood of disease (i.e, prevalence of the disease in the population). In ischemic heart disease, there are no absolute indications for exercise electrocardiographic testing in asymptomatic patients. However, it is the major noninvasive test for coronary artery disease (CAD). We prefer to use exercise testing whenever possible, because it provides physiologic data that may indicate prognosis and aid in decision making regarding medical treatment. In several situations, exercise assessment combined with radionuclide angiography or echocardiography is indicated for evaluation of patients with CAD. In certain groups of patients, pharmacologic stress testing is preferred. The two methods used most often are dipyridamole administration followed by thallium perfusion imaging and dobutamine administration followed by echocardiography. They have similar sensitivity, specificity, and diagnostic accuracy for CAD and CAD events. Coronary angiography, although invasive, remains the "gold standard" for assessment of CAD and its severity. It is most useful in combination with results of exercise testing. Beta-adrenergic blockers, calcium channel blockers, and nitrates have specific uses in CAD and should be chosen on the basis of their pharmacologic properties. Further details regarding non-pharmacologic and pharmacologic treatment and revascularization strategies in patients with CAD are discussed elsewhere in this symposium.
Lavie
C J
CJ
Ochsner Clinic and Alton Oshsner Medical Foundation, New Orleans, USA.
Milani
R V
RV
D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004452:Echocardiography; D005080:Exercise Test; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy*; D011875:Radionuclide Angiography
D002317:Cardiovascular Agents