In addition, the use of stress MPI improved clinical decision making for chest pain patients [44]. calcified coronary plaque, does not exclude acute coronary syndrome, significant coronary plaque burden, or plaque, which suggests that additional testing beyond CCS may be needed [48-50]. US Echocardiography Transthoracic Stress When echocardiography is performed, stress contraction abnormalities are induced by either exercise or inotropic stimulation. In any situation where a SPECT MPI study cannot be performed, an exercise-stress or dobutamine- stress echocardiogram may be substituted [51,52]. Stress echocardiography is used to evaluate for wall motion abnormalities and can provide data regarding flow reserve, which can aid in patient risk stratification [53]. US Echocardiography Transthoracic Resting In certain cases, if valvular heart disease, hypertrophic cardiomyopathy, or pericardial disease is the primary diagnostic concern, an echocardiogram at rest may be the preferred examination. The use of nonstress echocardiography in patients with stable chest pain when coronary artery disease is suspected may not reveal additional diagnostic information [54]. MRI Heart MRI is an emerging technology, and its clinical applications to cardiac imaging continue to develop. Currently, stress cardiac MRI and coronary MRA are available to diagnose CAD. Cardiac MRI without stress can be performed to evaluate valvular heart disease, nonischemic etiologies of chest pain, such as hypertrophic cardiomyopathy, or evaluate for pericardial disease. Stress cardiac MRI can be performed with dobutamine, adenosine, or dipyridamole. Dobutamine-stress functional cardiac MRI may also play a role in the assessment of chronic CCP [55]. This is especially true when the echocardiographic examination is nondiagnostic.
Chronic Chest Pain Noncardiac Etiology Unlikely Low to Intermediate Probability of Coronary Artery Disease PCAs. In addition, the use of stress MPI improved clinical decision making for chest pain patients [44]. calcified coronary plaque, does not exclude acute coronary syndrome, significant coronary plaque burden, or plaque, which suggests that additional testing beyond CCS may be needed [48-50]. US Echocardiography Transthoracic Stress When echocardiography is performed, stress contraction abnormalities are induced by either exercise or inotropic stimulation. In any situation where a SPECT MPI study cannot be performed, an exercise-stress or dobutamine- stress echocardiogram may be substituted [51,52]. Stress echocardiography is used to evaluate for wall motion abnormalities and can provide data regarding flow reserve, which can aid in patient risk stratification [53]. US Echocardiography Transthoracic Resting In certain cases, if valvular heart disease, hypertrophic cardiomyopathy, or pericardial disease is the primary diagnostic concern, an echocardiogram at rest may be the preferred examination. The use of nonstress echocardiography in patients with stable chest pain when coronary artery disease is suspected may not reveal additional diagnostic information [54]. MRI Heart MRI is an emerging technology, and its clinical applications to cardiac imaging continue to develop. Currently, stress cardiac MRI and coronary MRA are available to diagnose CAD. Cardiac MRI without stress can be performed to evaluate valvular heart disease, nonischemic etiologies of chest pain, such as hypertrophic cardiomyopathy, or evaluate for pericardial disease. Stress cardiac MRI can be performed with dobutamine, adenosine, or dipyridamole. Dobutamine-stress functional cardiac MRI may also play a role in the assessment of chronic CCP [55]. This is especially true when the echocardiographic examination is nondiagnostic.