Nuclear perfusion imaging and stress echocardiography show common pathophysiological roots and produce similar clinical fruits. They share a bipartisan imaging strategy to replace an anatomy-driven with a more physiologically oriented approach, referring to coronary angiography for ischemia-driven revascularization only patients with uncontrolled symptoms or a high-risk pattern of stress imaging. They are, more or less, equally reliable “gatekeepers” for more invasive, risky, and costly procedures, and have a recognized similar diagnostic and prognostic accuracy. On the basis of these well-established findings, the American College of Cardiology/American Heart Association guidelines concluded that “the choice of which test to perform depends on issues of local expertise, available facilities and considerations of cost-effectiveness.” However, the societal climate surrounding medical practice has become more sensitive to the biological costs of testing, and recent European guidelines have added that the advantages of stress echocardiography include its “being free of radiation.” If we put the choice of cardiac stress imaging in the wider context of medical imaging, the European Commission recommendations clearly state that a nonionizing test should always be preferred when the information is grossly comparable to an ionizing test and both are available. Applying these guidelines, whenever a stress imaging test is clinically indicated, stress echocardiography is the first-line test; when stress echocardiography is not feasible or yields ambiguous response, stress CMR is an excellent radiation-free option. If stress CMR technology and expertise are not available, stress radionuclide perfusion imaging can be considered.
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Keywords
- Positron Emission Tomography
- Cardiovascular Magnetic Resonance
- Myocardial Perfusion Imaging
- Nuclear Cardiology
- Coronary Flow Reserve
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Marwick, T.H., Picano, E. (2009). Stress Echocardiography Versus Stress Perfusion Scintigraphy. In: Picano, E. (eds) Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-76466-3_38
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