The role of noninvasive testing in evaluating patients for coronary artery disease

Risk stratification of patients with coronary artery disease using noninvasive imaging techniques has become increasingly more important in the cost-conscious delivery of patient care. This is evidenced by significant developments involving both nuclear cardiology and echocardiography for the assessment of viability, silent myocardial ischemia and prognosis, as well as the emergence of new techniques, in particular the use of positron emission tomography isotopes with single photon emission computed tomography cameras and low-dose dobutamine echocardiography in the detection of viability. New developments regarding screening for and the clinical importance of silent myocardial ischemia as well as new developments regarding classification of radionuclide perfusion defects and stress echocardiograms that portend a poor prognosis are also reviewed. Finally, new techniques and stress agents have been development that add to the choices available to the clinician for the optimal assessment of the patient being considered for revascularization.