Variations in the referral patterns to stress nuclear imaging and stress echocardiography scans
Salam Itani1, Walid Gharzuddine, Samir Arnaout
1Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
Insights
Patients referred for stress myocardial perfusion imaging (MPI) are older and have more coronary artery disease (CAD) risk factors than those referred for stress echocardiography (Echo). This impacts how diagnostic studies are interpreted.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Stress myocardial perfusion imaging (MPI) and stress echocardiography (Echo) are key noninvasive tools for diagnosing coronary artery disease (CAD).
- Limited research exists comparing patient profiles and referral patterns for these two cardiac imaging modalities.
Purpose of the Study:
- To compare patient characteristics, referral reasons, and referring physician types for stress MPI versus stress Echo.
- To analyze differences in patient risk factors and clinical outcomes between the two imaging modalities.
Main Methods:
- A prospective study of 1,020 consecutive patients referred for stress MPI or stress Echo in 2008.
- Analysis of patient demographics, medical history, and referral patterns.
Main Results:
- Patients referred for stress MPI were older with higher rates of diabetes, hypertension, hypercholesterolemia, smoking, and prior cardiac events.
- Stress MPI showed more abnormal scans (24% vs. 15%), higher ischemia prevalence (15% vs. 7.6%), and worse left ventricular function (11% vs. 1.7%).
- Stress Echo had a higher proportion of self-referred studies by interpreting physicians (31% vs. 19%).
Conclusions:
- Patients undergoing stress MPI represent a higher-risk population with more CAD risk factors and prior events compared to stress Echo patients.
- These differences are critical for accurately interpreting comparative diagnostic and prognostic studies of MPI and Echo.
Background:
Stress myocardial perfusion imaging (MPI) and stress echocardiography (Echo) are commonly used for the noninvasive evaluation of patients with suspected coronary artery disease (CAD). Very few studies have compared the referral patterns to these imaging modalities in terms of the clinical profile of patients, reasons for referral, and type of referring physicians.
Methods And Results:
This was a prospective study of 1,020 consecutive patients who were referred for stress MPI (429 patients) or stress Echo (591 patients) at the American University of Beirut Medical Center in the year of 2008. Patients referred to MPI were older and had a higher prevalence of diabetes, hypertension, hypercholesterolemia, smoking, and previous myocardial infarction, coronary angioplasty, or bypass surgery. There were more abnormal scans in the stress MPI group (24% vs 15%, P < 0.001), as well as a higher prevalence of ischemia (15% vs 7.6%, P < 0.001) and impaired left ventricular function with an ejection fraction <50% (11% vs 1.7%, P < 0.001). A higher percentage of stress Echo studies were self-referred by physicians who themselves interpret the scans (31% vs 19%, P < 0.001).
Conclusion:
Patients referred for stress MPI are at a higher risk than those referred for stress Echo having more CAD risk factors, more prior history of coronary events, and an older age. These findings have important implications in the interpretation of studies that compare the diagnostic and prognostic power of these two imaging modalities.
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