Evaluation of Ischemic Heart Disease: Standard Imaging and Diagnostic Testing Modalities

Coronary artery disease (CAD) is a major cause of morbidity and mortality in United States. There are substantial costs of treating this disease. Early diagnosis of this disease is likely to result in improved health, longer life span, and significant cost savings. There are many modalities available for evaluation and early detection of CAD in patients with known or clinically suspected ischemic heart disease (IHD). These modalities include standard exercise tolerance test (ETT), nuclear cardiology techniques including radionuclide myocardial perfusion and function imaging with SPECT or PET, MUGA (ERNA) blood pool imaging, echocardiography, cardiac CT, cardiac MRI, and invasive coronary angiography. Anyone treating a patient with suspected CAD needs to be familiar with the role of each of these modalities in evaluation of the patient. Our goal is to help the reader understand unique role and indication of each of these imaging modalities in evaluation of patients with suspected ischemic heart disease, so that appropriate choices can be made in selecting diagnostic tests for the patients. The role of screening for CAD with coronary calcium scanning in patients with high burden of coronary risk factors without clinical signs or symptoms will also be reviewed.