A meta-analysis of 44 studies including patients with suspected or known CAD indicated that stress echocardiography has a sensitivity of 85% and a specificity of 77% in detection of CAD (defined as >50% coronary artery luminal diameter stenosis) [72]. In patients with suspected or known CAD, inducible wall motion abnormality during dobutamine stress echocardiography is associated with a higher risk for subsequent cardiac events. Patients with negative dobutamine stress echocardiography exhibited a lower event rate [47]. US contrast-enhanced stress echocardiography improves endocardial visualization. A single-center prospective randomized trial that included 229 patients with suspected or know CAD has demonstrated diagnostic test rates of 100% for contrast-enhanced stress echocardiography [73]. A single-center prospective study of 101 patients with an intermediate to high probability of CAD based on clinical parameters and risk factors has demonstrated that administration of an echocardiography contrast agent (ie, microbubbles) improves endocardial visualization at rest and more so during stress, leading to a more precise interpretation with greater accuracy in evaluating CAD in patients with 2 or more nonvisualized segments and low confidence of interpretation [71,74]. Variant 2: Chronic chest pain; high probability of coronary artery disease. Known ischemic heart disease with no prior definitive treatment. Initial imaging. In this clinical scenario, prior definitive treatment is defined as previous coronary artery angioplasty, stent placement, or coronary arteries bypass graft. Arteriography Coronary Catheter-based selective coronary angiography is historically considered the coronary imaging modality of choice with the highest spatial and temporal resolution.
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. A meta-analysis of 44 studies including patients with suspected or known CAD indicated that stress echocardiography has a sensitivity of 85% and a specificity of 77% in detection of CAD (defined as >50% coronary artery luminal diameter stenosis) [72]. In patients with suspected or known CAD, inducible wall motion abnormality during dobutamine stress echocardiography is associated with a higher risk for subsequent cardiac events. Patients with negative dobutamine stress echocardiography exhibited a lower event rate [47]. US contrast-enhanced stress echocardiography improves endocardial visualization. A single-center prospective randomized trial that included 229 patients with suspected or know CAD has demonstrated diagnostic test rates of 100% for contrast-enhanced stress echocardiography [73]. A single-center prospective study of 101 patients with an intermediate to high probability of CAD based on clinical parameters and risk factors has demonstrated that administration of an echocardiography contrast agent (ie, microbubbles) improves endocardial visualization at rest and more so during stress, leading to a more precise interpretation with greater accuracy in evaluating CAD in patients with 2 or more nonvisualized segments and low confidence of interpretation [71,74]. Variant 2: Chronic chest pain; high probability of coronary artery disease. Known ischemic heart disease with no prior definitive treatment. Initial imaging. In this clinical scenario, prior definitive treatment is defined as previous coronary artery angioplasty, stent placement, or coronary arteries bypass graft. Arteriography Coronary Catheter-based selective coronary angiography is historically considered the coronary imaging modality of choice with the highest spatial and temporal resolution.