Stress Myocardial Perfusion Imaging

Exercise perfusion imaging appears to be superior to exercise ECG alone in detecting CAD, in identifying multivessel disease, in localizing diseased vessels, and in determining the extent of ischemic and infarcted myocardium. Perfusion imaging is also useful for detecting myocardial viability in patients with left ventricular dysfunction, either regional or global, with or without Q waves, and provides important information with regard to risk stratification and therapeutic strategies.6 Stress myocardial imaging is particularly valuable in the diagnosis of CAD in patients with abnormal resting ECG and those in whom ST-segment responses cannot be interpreted accurately, such as patients with left ventricular hypertrophy, those with left bundle branch block or pre-excitation syndrome, and those receiving digitalis. Stress myocardial perfusion scintigraphy should not be used as a screening test in patients with low pretest probability of CAD, because the majority of abnormal tests will yield false-positive results.7 Given that the results with thallium-201 are comparable to those obtained with 99mTc-sestamibi or 99mTc-tetrofosmin, these agents can, generally, be used interchangeably for the diagnosis of CAD.6 For patients who are unable to exercise, especially the elderly and those with peripheral vascular disease, pulmonary disease, arthritis, or a previous stroke,pharmacological vasodilator stress with dipyridamole or adenosine may be used.

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