Track topics on Twitter Track topics that are important to you
The first step towards approaching a patient with an inconclusive stress test is to identify the initial reason why a stress test was ordered and examine what factors led to inconclusive test results. Next, it is important to ask whether the patient will benefit from further testing, as not all patients with inconclusive test results require additional testing. In patients who are at low-to-intermediate risk, it may be useful to perform coronary CT angiography (CTA) to exclude the presence of obstructive coronary atherosclerosis. Among individuals with no prior history of coronary artery disease, a possible advantage of CTA is that if subclinical atherosclerosis is identified, intensification of lifestyle interventions, and often pharmacotherapy, should be advocated. On the other hand, in high-risk patients or individuals that already have coronary artery disease, the primary objective is to quantify the presence and magnitude of ischemia in order to define the potential role of coronary revascularization procedures. This can be achieved by myocardial perfusion imaging using nuclear imaging or cardiac MRI. Alternatively, a functional evaluation to identify stress-induced wall motion abnormalities using stress echocardiography or MRI can be obtained. In selecting which test to obtain, it is important to understand the strengths and limitations of different imaging tests and to consider patient factors (e.g., body habitus) that may influence the accuracy of various tests. In addition, physicians should consider whether there are any other clinical questions that require imaging. For instance, cardiac MRI may be used to evaluate for infiltrative myocardial disease or pericardial disease whereas cardiac CT can evaluate for lung pathology or diseases of the aorta. Finally, any decision regarding what type of additional testing to obtain should also be based on knowing the local expertise and availability of various testing options.
Non-invasive Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Room Shapiro 5096, Boston, MA, 02115, USA.
This article was published in the following journal.
Name: Current treatment options in cardiovascular medicine
Imaging is the modality of choice for noninvasive characterization of biological tissue and organ systems; imaging serves as early diagnostic tool for most disease processes and is rapidly evolving, t...
Too often, in clinical settings, the diagnosis and evolution of lymphedema is determined by limb circumference measurements and/or volume calculations. Besides the unrecognition of small lymphedemas, ...
Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digi...
With the advent of novel treatment strategies to help widen the therapeutic window for patients with oligometastatic cancer, improved biomarkers are needed to reliably define patients who can benefit ...
Using noninvasive magnetic resonance imaging techniques to accurately evaluate the grading and cellularity of gliomas is beneficial for improving the patient outcomes. Amide proton transfer imaging is...
The overall goal of this study is to evaluate agreement between cardiac MR parameters and well-established clinical and catheterization parameters of poor prognosis in patients with pulmon...
The aim of this study is to address the usefulness of carotid duplex ultrasound as vascular imaging for selecting acute stroke patients for endovascular thrombectomy.
The goal of the proposed research is to test the feasibility of a functional progression program to reduce cost and possible radiation exposure for adolescent athletes with low back pain. ...
This study will apply novel, noninvasive structural and functional magnetic resonance imaging (MRI) methods to patients with mild and moderate breast cancer-related lymphedema (BCRL) for t...
The purpose of this study is to test another way to control the amount of HIV in the blood (viral load). Studies show that stopping all anti-HIV drugs for a time before switching to new a...
Visualization of the heart structure and cardiac blood flow for diagnostic evaluation or to guide cardiac procedures via techniques including ENDOSCOPY (cardiac endoscopy, sometimes refered to as cardioscopy), RADIONUCLIDE IMAGING; MAGNETIC RESONANCE IMAGING; TOMOGRAPHY; or ULTRASONOGRAPHY.
The use of molecularly targeted imaging probes to localize and/or monitor biochemical and cellular processes via various imaging modalities that include RADIONUCLIDE IMAGING; ULTRASONOGRAPHY; MAGNETIC RESONANCE IMAGING; fluorescence imaging; and MICROSCOPY.
Work consisting of a clinical trial involving one or more test treatments, at least one control treatment, specified outcome measures for evaluating the studied intervention, and a bias-free method for assigning patients to the test treatment. The treatment may be drugs, devices, or procedures studied for diagnostic, therapeutic, or prophylactic effectiveness. Control measures include placebos, active medicine, no-treatment, dosage forms and regimens, historical comparisons, etc. When randomization using mathematical techniques, such as the use of a random numbers table, is employed to assign patients to test or control treatments, the trial is characterized as a RANDOMIZED CONTROLLED TRIAL.
Clinical trials involving one or more test treatments, at least one control treatment, specified outcome measures for evaluating the studied intervention, and a bias-free method for assigning patients to the test treatment. The treatment may be drugs, devices, or procedures studied for diagnostic, therapeutic, or prophylactic effectiveness. Control measures include placebos, active medicines, no-treatment, dosage forms and regimens, historical comparisons, etc. When randomization using mathematical techniques, such as the use of a random numbers table, is employed to assign patients to test or control treatments, the trials are characterized as RANDOMIZED CONTROLLED TRIALS AS TOPIC.
A radionuclide imaging agent used primarily in scintigraphy or tomography of the heart to evaluate the extent of the necrotic myocardial process. It has also been used in noninvasive tests for the distribution of organ involvement in different types of amyloidosis and for the evaluation of muscle necrosis in the extremities.
Stress is caused by your perception of situations around you and then the reaction of your body to them. The automatic stress response to unexpected events is known as 'fight or flight'. Discovered by Walter Cannon in 1932, it is the release of h...
Radiology is the branch of medicine that studies imaging of the body; X-ray (basic, angiography, barium swallows), ultrasound, MRI, CT and PET. These imaging techniques can be used to diagnose, but also to treat a range of conditions, by allowing visuali...