Charles Pollick MBChB, FRCP, FACC, FASE€¦ · SE is an excellent test for the diagnosis of CAD...

Charles Pollick MBChB, FRCP, FACC, FASE

Real time structural and functional

information

Rapid turn around for patient decision

making

Low cost

Portable

Widely available

No ionizing radiation

Minimal patient discomfort

Exercise provoked myocardial

ischemia leads to segmental wall

motion abnormalities detectable by

echocardiography

Pacing

Pharmacological

Treadmill

Supine bicycle

Upright bicycle Dobutamine

Dipyridamole

Adenosine

Exercise

Transesophageal

Direct atrial

Causes that may be identifiable by stress echo

coronary artery disease

aortic stenosis

hypertrophic cardiomyopathy

pulmonary hypertension

pericarditis

RECOVERY RECOVERY

8 mmHg 34 mmHg

Recovery

REST PEAK RECOVERY

110 mmHg

Patient 1:

70 yo man with dyspnea on exertion

Bruce protocol 11 min 0 sec. Peak HR 139 bpm. No chest pain.

Outcome:

stent to the LAD

Patient 2:

44 yo man with dyspnea on exertion

Bruce protocol: 6 min 13 sec. 7.6 METs. Peak HR 141 bpm.

Outcome:

LIMA to LAD and SVGs to distal LAD and Cx marginal

Normal wall motion

As effective as for unknown CAD

Abnormal wall motion

Less effective for discerning new or larger WMAs

15 years ago I was asked to learn nuclear cardiology….

Let me come clean…

Downtown Outpatient non-invasive lab

Stats for Jan 1 2017 to Nov 14 2017

Stress echo: 813

SPECT: 373

SE is an excellent test for the diagnosis of

CAD

MPI has the edge when it comes to patients

with known CAD and resting WMAs

Some interventionalists seem to prefer MPI

as they think it is more sensitive

Patients who have never had a cardiac test

are better served by a stress echo than an

MPI

The PROMISE study suggests that “functional

imaging” may become passé