Noninvasive Evaluation of CAD

Stress testing (JACC 2012;60:1828; J Nucl Cardiol 2016; 23:606)

  • Indications: dx obstructive CAD, evaluate ∆ in clinical status in Pt w/ known CAD, risk stratify after ACS, evaluate exercise tolerance, localize ischemia (imaging required)
  • Contraindications (Circ 2002;106:1883; & 2012;126:2465)
    • Absolute: AMI w/in 48 h, high-risk UA, acute PE, severe sx AS, uncontrolled HF, uncontrolled arrhythmias, myopericarditis, acute aortic dissection
    • Relative (discuss with stress lab): left main CAD, mod symptomatic valvular stenosis, severe HTN, HCMP, high-degree AVB, severe electrolyte abnl

Exercise tolerance test (w/ ECG alone)

  • Generally preferred if Pt ngfully exercise; ECG ∆s w/ Se ~65%, Sp ~80%