COMPARISON OF MODALITIES TO DIAGNOSE CORONARY-ARTERY DISEASE

The purpose of this review is to compare several modalities available for detection of coronary artery disease (CAD). We compare the clinica l history, rest/exercise electrocardiogram (ECG), rest/stress left ven tricular (LV) function by radionuclide or echocardiographic methods, m yocardial perfusion imaging (MPI) by single photon emission computed t omography (SPECT) or positron emission tomography (PET), contrast coro nary angiography, magnetic resonance imaging (MRI), spectroscopy (MRS) and angiography (MRA), and ultrafast cine computed tomography (UFCT) to assess LV function, myocardial perfusion, and coronary calcificatio n. We compare the modalities by answering six questions: (1) Does the modality provide unique clinical information? (2) What is the observer error? (3) What are sensitivities and specificities to detect CAD? (4 ) What patient selection criteria should be applied for each modality? (5) What incremental benefit is obtained from one modality versus ano ther modality? and (6) Where do the modalities fit in the overall sche me of diagnostic testing for CAD? PET MPI appears to be the best nonin vasive test for CAD, followed by SPECT thallium-201 and then dobutamin e echocardiography. MRA and UFCT may soon play a larger role because t hey visualize the arteries. Contrast coronary angiography remains the gold standard despite its limitations. Exercise ECG is the least accur ate test. The choice of tests critically depends on patient selection- based on clinical history, age, gender, and risk factors to estimate t he pretest, clinical probability of CAD.