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World J Cardiol. Apr 26, 2017; 9(4): 304-311
Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.304
Coronary artery disease detection - limitations of stress testing in left ventricular dysfunction
Ritin Bomb, Senthil Kumar, Anand Chockalingam
Ritin Bomb, Senthil Kumar, Anand Chockalingam, Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO 65212, United States
Ritin Bomb, Senthil Kumar, Anand Chockalingam, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65212, United States
Author contributions: Bomb R performed the majority of the writing; Kumar S reviewed the available literature and edited the draft versions; Chockalingam A designed the outline and coordinated the manuscript preparation.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anand Chockalingam, MD, FACC, FAHA, FASE, Associate Professor of Clinical Medicine, Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO 65212, United States. chockalingama@health.missouri.edu
Telephone: +1-573-8822296 Fax: +1-573-8847743
Received: September 20, 2016
Peer-review started: September 23, 2016
First decision: November 2, 2016
Revised: January 5, 2017
Accepted: February 8, 2017
Article in press: February 13, 2017
Published online: April 26, 2017
Processing time: 220 Days and 2.6 Hours
Abstract

Incidental diagnosis of left ventricular systolic dysfunction (LVD) is common in clinical practice. The prevalence of asymptomatic LVD (Ejection Fraction, EF < 50%) is 6.0% in men and 0.8% in women and is twice as common as symptomatic LVD. The timely and definitive exclusion of an ischemic etiology is central to optimizing care and reducing mortality in LVD. Advances in cardiovascular imaging provide many options for imaging of patients with left ventricular dysfunction. Clinician experience, patient endurance, imaging modality characteristics, cost and safety determine the choice of testing. In this review, we have compared the diagnostic utility of established tests - nuclear and echocardiographic stress testing with newer techniques like coronary computerized tomography and cardiac magnetic resonance imaging and highlight their inherent limitations in patients with underlying left ventricular dysfunction.

Keywords: Coronary artery disease; Stress testing; Left ventricular dysfunction; Myocardial perfusion imaging; Dobutamine stress echocardiography

Core tip: Left ventricular systolic dysfunction is common in clinical practice and may be detected in asymptomatic patients. The timely and definitive exclusion of an ischemic etiology is central to optimizing care and reducing mortality. Clinician experience, imaging modality characteristics, cost and safety determine the choice of testing. We compare the diagnostic utility of established tests like nuclear and echocardiographic stress testing with newer techniques like coronary computerized tomography and cardiac magnetic resonance imaging. Due to limitations inherent to each non-invasive modality, oftentimes cardiac catheterization remains the definitive method to exclude coronary artery disease in patients with underlying left ventricular dysfunction.