Imaging-for-stress-test

• Use if uninterpretable ECG (V-paced, LBBB, resting ST ↓ >1 mm, digoxin, LVH, WPW), after indeterminate ECG test, or if pharmacologic test

• Use when need to localize ischemia (often used if prior coronary revasc)

• Radionuclide myocardial perfusion imaging w/ images obtained at rest & w/ stress

SPECT (eg, 99mTc-sestamibi): Se ~85%, Sp ~80%

PET (rubidium-82): Se ~90%, Sp ~85%; requires pharmacologic stress, not exercise

ECG-gated imaging allows assessment of regional LV fxn (sign of ischemia/infarction)

• Echo (exercise or dobuta): Se ~80%, Sp ~85%; no radiation; operator dependent