Stress Testing and Advanced Imaging for Initial Diagnosis
in Patients With Suspected SIHD Who Require Noninvasive
Testing
Able to Exercise
Î Standard exercise ECG testing is recommended for patients with an
intermediate pretest probability of IHD who have an interpretable
ECG and at least moderate physical functioning or no disabling
comorbidity. (I-A)
Î Exercise stress with nuclear myocardial perfusion imaging (MPI) or
echocardiography is recommended for patients with an intermediate
to high pretest probability of IHD who have an uninterpretable
ECG and at least moderate physical functioning or no disabling
comorbidity. (I-B)
Î For patients with a low pretest probability of obstructive IHD who do
require testing, standard exercise ECG testing can be useful, provided
the patient has an interpretable ECG and at least moderate physical
functioning or no disabling comorbidity. (IIa-C)
Î Exercise stress with nuclear MPI or echocardiography is reasonable
for patients with an intermediate to high pretest probability of
obstructive IHD who have an interpretable ECG and at least moderate
physical functioning or no disabling comorbidity. (IIa-B)
Î Pharmacological stress with cardiac magnetic resonance (CMR) can
be useful for patients with an intermediate to high pretest probability
of obstructive IHD who have an uninterpretable ECG and at least
moderate physical functioning or no disabling comorbidity. (IIa-B)
Î Coronary/cardiac computed tomography angiography (CCTA) might
be reasonable for patients with an intermediate pretest probability of
IHD who have at least moderate physical functioning or no disabling
comorbidity. (IIb-B)
Î For patients with a low pretest probability of obstructive IHD who do
require testing, standard exercise stress echocardiography might be
reasonable, provided the patient has an interpretable ECG and at least
moderate physical functioning or no disabling comorbidity. (IIb-C)
Î Pharmacological stress with nuclear MPI, echocardiography, or
cardiac magnetic resonance (CMR) is NOT recommended for patients
who have an interpretable ECG and at least moderate physical
functioning or no disabling comorbidity. (III-C: No Benefit)
ÎExercise stress with nuclear MPI is NOT recommended as an initial test
in low-risk patients who have an interpretable ECG and at least moderate
physical functioning or no disabling comorbidity. (III-C: No Benefit)
Diagnosis
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