DIAGNOSIS AND RISK STRATIFICATION IN CORONARY-ARTERY DISEASE - NUCLEAR CARDIOLOGY VERSUS STRESS ECHOCARDIOGRAPHY

Both myocardial perfusion imaging and stress echocardiographic techniq ues have evolved tremendously during the past decade and now play a ma jor role in the evaluation and management of patients with known or su spected coronary artery disease (CAD), Each method requires clinical e xperience and technical expertise, and each has potential advantages a nd disadvantages that, in a given institution or practice setting, may make one or the other perform more accurately, more efficiently, or m ore cost-effectively. Stress echocardiography offers a relatively cost -effective method for cardiac imaging, and this technique is often vie wed as a lower-cost alternative to myocardial perfusion imaging, The a vailable data reported in the literature indicate that stress echocard iography and myocardial perfusion imaging provide comparable results f or the diagnosis of CAD, However, in many situations the presence or a bsence of CAD is less important than determining the extent and severi ty of disease and identifying patient subgroups at high risk and low r isk. From this perspective, myocardial perfusion imaging provides grea ter sensitivity than stress echocardiography for detecting the presenc e and extent of ischemic, jeopardized myocardium and for identifying v iable yet dysfunctional myocardium. This greater sensitivity translate s into more reliable prognostic information than that provided by stre ss echocardiography, This ability to predict which patients are at ris k of subsequent cardiac events, and which are at extremely low risk an d can be followed safely without further evaluation, may reduce the lo ng-term costs of treating CAD? even though the short-term costs of str ess echocardiography mag be lower.