SHOULD THE DIAGNOSIS OF CORONARY-ARTERY DISEASE BE BASED ON THE EVALUATION OF MYOCARDIAL-FUNCTION OR PERFUSION

The aim of this review was to define the place of stress (exercise. do butamine, and vasodilator) echocardiography in the context of perfusio n scintigraphic techniques for the detection of coronary artery diseas e. Echocardiography and nuclear imaging have their strong and weal; po ints. Echocardiograph has the benefit of widespread availability, rela tively low cost, portability, absence of radiation, safety, and determ ination of ischaemic threshold. However, echocardiographic imaging can not be performed during treadmill exercise, the echocardiographic wind ows are variable with sometimes poor echogenicity, and interpretation is subjective and requires an important learning curve. Diagnostic com parisons were focused on studies involving echocardiographic and nucle ar imaging in the same patients. These direct comparisons show that ex ercise or dobutamine echocardiography and perfusion imaging have simil ar accuracies for the detection and localization of coronary artery di sease. Perfusion imaging may be more sensitive in the detection of mil d coronary artery disease; echocardiography, however, has a better spe cificity. Vasodilator perfusion imaging is superior to vasodilator ech ocardiography, although the new dipyridamoleatropine echocardiography test will make future reassessment neccesary. Once the condition of ad equate echocardiographic training is fulfilled, we believe that the se lection of one or other test should be tailored to clinical circumstan ces rather than be a uniform decision.