15. TC coronarica
Limiti:
• valutazione anatomica della stenosi e non dà
informazioni sulla rilevanza funzionale della
lesioni
• utilizzo del mezzo di contrasto iodato
• basso valore preddittivo positivo
Linee Guida ESC 2006 Angina stabile
16. ECO stress
Limiti:
• qualità della finestra acustica e conseguente qualità
dell’immagine
• fortemente operatore dipendente, l’analisi del
movimento regionale e delle sue modificazioni transitorie
richiede molta esperienza
• sensibilità ridotta in caso di malattia di un singolo vaso
• disfunzione diastolica e sistolica più tardiva nella cascata
ischemica rispetto alle alterazioni della perfusione
Marwick T: Stress echocardiography Heart 2008
21. SPECT vs ECG da sforzo post CABG
Elhendy et al. J Nucl Cardiol 1998
22.
23.
24. Comparison of stressechocardiography and stress myocardial perfusion scintigraphy for
diagnosing coronary artery disease and assessing its severity
MD James H. O'Keefe Jr. ,
Carrie S. Barnhart,
MD Timothy M. Bateman
From Cardiovascular Consultants, Mid America Heart Institute, St. Luke's Hospital, University of Missouri-
Kansas City, Kansas City, Missouri, USA
The cumulative published literature dealing with the most frequently utilized noninvasive
cardiac stress imaging modalities (radionuclide myocardialperfusionscintigraphy and
echocardiography) was reviewed to gain insight on their comparative diagnostic accuracies.
To be included, studies had to be performed in conjunction with exercise or a commonly
used intravenous pharmacologic stress agent (dipyridamole, adenosine or dobutamine) and
had to report temporally related coronary angiography findings. A total of > 75 studies were
included, involving > 7,000 patients. Exercise single-photon emitted computed tomographic
(SPECT) scintigraphy was more sensitive than exercise echocardiography for detecting
coronary artery disease (CAD), localizing it to the proper coronary artery distribution and
correctly identifying the presence of multivessel CAD. Adenosine, dipyridamole, and
dobutamine provided similar diagnostic accuracy when performed in conjunction with SPECT
scintigraphy, and all were more accurate than dobutamine echocardiography. Clinical
specificity was similarly high with adenosine SPECT, dipyridamole echocardiography, and
exercise echocardiography, and lower with exercise SPECT. Normalcy rate was high for
exercise SPECT and similar to clinical specificity for echocardiography.
The American Journal of Cardiology, Volume 75, Issue 11, Supplement 1, 13 April 1995, Pages 25D-34D
James H. O'Keefe Jr., Carrie S. Barnhart, Timothy M. Bateman