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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