Coronary artery disease detection - limitations of stress testing in left ventricular dysfunction

Table 1 Comparative analysis of the sensitivity, specificity and diagnostic accuracy for coronary artery disease detection using various imaging modalities¹

Modality	Sensitivity	Specificity	Positive predictive value	Negative predictive value	Diagnostic accuracy
SPECT	80%-100%	40%-50%	90%-95%	90%-95%	75%-80%
DSE	80%-85%	60%-80%	80%-90%	45%-60%	75%-80%
PET	85%-90%	80%-85%	85%-90%	80%-95%	80%-85%
CCT	70%-90%	85%-90%	90%-95%	90%-95%	90%-95%
CMR	95%-100%	90%-95%	90%-95%	90%-95%	95%-100%

¹This data is limited as it includes both patients with and without left ventricular dysfunction. DSE: Dobutamine stress echocardiography; SPECT: Single photon emission computerized tomography; PET: Positron emission tomography; CCT: Coronary computerized tomography; CMR: Cardiac magnetic resonance imaging.

Table 2 Key advantages and limitations of various imaging modalities in detection of coronary artery disease in patients with left ventricular dysfunction

Modality	Advantages	Limitations
SPECT	Wide availability	Radiation
		May miss left main and triple vessel disease
DSE	Wide availability	Inter-observer variability
	Evaluates valves and pericardium	Nonspecific response to inotrope in LVD
PET	Viability evaluation	Radiation
	Quantifies myocardial blood flow
CCT	Anatomic information like invasive angiogram	Radiation
		Iodinated contrast in renal dysfunction
CMR	Evaluates valves and pericardium Viability evaluation	Gadolinium in renal dysfunction
	Determine etiology of DCM

DSE: Dobutamine stress echocardiography; SPECT: Single photon emission computerized tomography; PET: Positron emission tomography; CCT: Coronary computerized tomography; CMR: Cardiac magnetic resonance imaging; LVD: Left ventricular systolic dysfunction.