Diagnostic Accuracy and Clinical Utility of Noninvasive Testing for Coronary Artery Disease
Authors: Annick C. Weustink, Pim J. de Feyter
Journal: Annals of Internal Medicine (2011)

Letters15 February 2011Diagnostic Accuracy and Clinical Utility of Noninvasive Testing for Coronary Artery DiseaseAnnick C. Weustink, MD, PhD and Pim J. de Feyter, MD, PhDAnnick C. Weustink, MD, PhDFrom Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.Search for more papers by this author and Pim J. de Feyter, MD, PhDFrom Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-4-201102150-00015 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The increase of radiation exposure associated with medical imaging studies is concerning and, when possible, should be avoided. In symptomatic patients with a low pretest probability of CAD, negative ECG stress test results—just like a normal contrast-enhanced computed tomographic scan of the coronary arteries—are associated with a very low posttest probability of CAD and do not warrant further downstream testing.We prefer to use ECG stress testing as an initial study because it is widely available and inexpensive and causes no radiation exposure. If, however, patients with a low pretest probability of CAD have positive ECG stress test results, these results are highly likely to be false-positive.A second functional test may be justified in some patients, depending on the severity of symptoms and occurrence of ST-segment depression during minimal or moderate exercise. Local availability and experience would determine whether this second test would be stress echocardiography or, preferably, pharmacologic SPECT, which has prognostic value and provides objective evidence of ischemia that is required for revascularization treatment.Annick C. Weustink, MD, PhDPim J. de Feyter, MD, PhDErasmus University Medical Center3000 CA Rotterdam, the Netherlands Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnostic Accuracy and Clinical Utility of Noninvasive Testing for Coronary Artery Disease Annick C. Weustink , Nico R. Mollet , Lisan A. Neefjes , W. Bob Meijboom , Tjebbe W. Galema , Carlos A. van Mieghem , Stamatis Kyrzopoulous , Rick Neoh Eu , Koen Nieman , Filippo Cademartiri , Robert-Jan van Geuns , Eric Boersma , Gabriel P. Krestin , and Pim J. de Feyter Diagnostic Accuracy and Clinical Utility of Noninvasive Testing for Coronary Artery Disease Ali Salavati , Farid Radmanesh , and Shadi A. Esfahani Metrics 15 February 2011Volume 154, Issue 4Page: 290KeywordsComputed axial tomographyConflicts of interestDiagnostic imagingEchocardiographyExerciseIschemiaRadiation exposureRevascularizationStable coronary artery disease ePublished: 15 February 2011 Issue Published: 15 February 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...