Myocardial stress imaging: a clinical tool has come of age

Coronary artery disease is a major cause of morbidity and mortality in the western world (1 ). Depending on the progression and severity of coronary artery disease and the myocardial response this may result in angina pectoris, myocardial infarction, chronic ischemic heart disease and cardiac death. Several techniques have been developed to evaluate patients with known or suspected coronary artery disease. In 1973, Strauss and Zaret and coworkers (2,3) hypothesized that exercise should be used to maximize differences in relative perfusion bet\veen normal and abnormal coronary vascular beds during myocardial perfusion imaging. This is a safe and simple noninvasive way of assessing myocardial perfusion at rest and to detect myocardial ischemia. In 1979, Wann and colleagues (4) demonstrated that the mechanical consequences of ischemia can be detected noninvasively by real-time two-dimensional stress echocardiography. Since then, advances in exercise and pharmacological stress protocols, developments in nuclear cardiology, and significant improvements in echocardiographic equipment have provided the foundation for the growth of myocardial stress imaging (5-11 ). Myocardial stress imaging has seen little to parallel its rapid development. Currently, noninvasive imaging of the heart using radionuclide tracers under stress and resting conditions and dobutamine stress echocardiography are established techniques for the evaluation of patients with known or suspected coronary artery disease. Myocardial stress imaging can be used for the detection, localization and determination of the functional significance of coronary heart disease, preoperative risk stratification, and assessment of prognosis (5-11). Furthermore, myocardial viability can be evaluated with dual-isotope nuclear imaging and dobutamine stress echocardiography (12,13). As a result, myocardial stress imaging has become the workhorse of cardiologists for the evaluation of patients with (suspected) ischemic heart disease. This thesis deals with myocardial stress imaging, and focuses on both nuclear imaging and dobutamine stress echocardiography

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