slides
Myocardial stress imaging: a clinical tool has come of age
- Publication date
- 27 November 2002
- Publisher
- Coronary artery disease is a major cause of morbidity and mortality in the western
world (1 ). Depending on the progression and severity of coronary artery disease and the
myocardial response this may result in angina pectoris, myocardial infarction, chronic
ischemic heart disease and cardiac death. Several techniques have been developed to evaluate
patients with known or suspected coronary artery disease.
In 1973, Strauss and Zaret and coworkers (2,3) hypothesized that exercise should be
used to maximize differences in relative perfusion bet\veen normal and abnormal coronary
vascular beds during myocardial perfusion imaging. This is a safe and simple noninvasive
way of assessing myocardial perfusion at rest and to detect myocardial ischemia. In 1979,
Wann and colleagues (4) demonstrated that the mechanical consequences of ischemia can be
detected noninvasively by real-time two-dimensional stress echocardiography. Since then,
advances in exercise and pharmacological stress protocols, developments in nuclear
cardiology, and significant improvements in echocardiographic equipment have provided the
foundation for the growth of myocardial stress imaging (5-11 ).
Myocardial stress imaging has seen little to parallel its rapid development. Currently,
noninvasive imaging of the heart using radionuclide tracers under stress and resting
conditions and dobutamine stress echocardiography are established techniques for the
evaluation of patients with known or suspected coronary artery disease. Myocardial stress
imaging can be