Table-3

Table-3. Common Stress testing Procedure for the Evaluation of Cheast Pain *TESTPROTOCOLPOSITIVE RESULTCOMMENTSEstimated

sensitivity

(%)Estimated

Specificity (%)

Standard treadmillor bicycle exercisePatient able to perform adequate amount of phys-

ical activityBaseline ECG is normal or near normal (e.g. mi-

nimal ST-segment depression)

Should not be used if patient has left-bunlde- branch block or electronic pacemakerNew horizontal or down-aloping ST seg-

ment depression 1mm or 2 mm in

pre-sence of baseline repolarization

abnor-malityBlood pressure response, exercise duration,ventricular arrhythmias,Duke treadmill score, and heart rate recovery should also be assessed.Functional capacity and Duke treadmill score have significant prognostic value 65-75 70-75

Exercise stress achocardiographyPatient able to perform physical activity.Two-dimensional echocardigram immediately after exerciseOne or more new segmental wall-motion abnor-

malities (hypokinesis,akinesis, or dyskinesis), left ventricular dilation, or both.Useful for abnormal baseline ECG (should not be used if patient has left-bundle-branch block or electronic pacemaker)Technically high quality echocardiogram is essential80-8580-85

Dobutamine stress echocardiographyFor patients unable to exercise adequately with or without abnormal ECGIncremental dobutamine infusionInducible segmental left ventricular wall-motion ab-

normalities,worsening of existing wall-motion abnormalities, or left ventricular dilationTechnically high-quality echocardiogram is essenstial80-8585-90

Exercise myocardial perfusion SPECT, with quantitative analysisFor patients able to perform physical acivityShoul be used when results of baseline ECG preclude assessment of ischemia (eg, nonspecific ST-T changes)

Can be used in patients with left-bundle-branch block or electronic pacemaker.Inducible single or multiple perfusion abnormalities ; left ventricular dilationAlso can provide information on left ventri-

cular function and wall motion85-9085-90

Pharmacologic myocardial perfusion SPECT, with quantitative analysisFor patients unable to exercise adequatelyIntravenous adenosine or dipyridamole

Can be used in patients with left-bundle-branch block or electronical paced rhythmProvides information similar to that pro-

vided by exercise SPECT80=9080-90

Electron-beam computated tomographyCalcium score closely correlates with extent of coronary atherosclerosisIf score > 100, consider follow up stress testCannot predict coronary obstruction or detect vulnerable plaque or degree of stenosis.Poorly soecificity. - -

* Estimates of sensitivity and specificity are derived from multiple database and from chronic stable angina guidelines of the American College of Cardilogy and the American Heart Association. The sensitivity, specificity, and predictive accuracy of all noninvasive stress testing methods are influenced by age, sex, degree of coronary atherosclerosis, and, most important, the likelihood of coronary artery disease in the opatien being tested. ECG denotes electrocardiogram, and SPECT single-photon-emission computated tomography.