Chronic stable angina risk stratification cardiac stress imaging in patients who are able to exercise
Chronic stable angina Microchapters | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
Diagnosis | ||
Alternative Therapies for Refractory Angina | ||
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Chronic stable angina risk stratification cardiac stress imaging in patients who are able to exercise On the Web | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]; Associate Editors-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Cardiac stress imaging consisting of echocardiography and myocardial perfusion scan, which are assessed both at rest and during stress, provide a useful way to stratify the risk of underlying coronary artery disease (CAD) and hence aid in the management of chronic stable angina. Cardiac stress imaging in a patient who is able to exercise is indicated in the presence of resting ECG abnormalities or in patients who are on digoxin. A normal post-stress thallium scan indicates a low probability of underlying CAD, however, a normal image in a patient with high-risk treadmill scores requires further evaluation. [1]
ACC / AHA Guidelines- Cardiac Stress Imaging for Risk Stratification of Patients With Chronic Stable Angina Who Are Able to Exercise (DO NOT EDIT)[2]
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Class I1. Exercise myocardial perfusion imaging or exercise echocardiography to identify the extent, severity, and location of ischemia in patients who do not have left bundle-branch block or an electronically paced ventricular rhythm and have either an abnormal rest ECG or are using digoxin. (Level of Evidence: B) 2. Dipyridamole or adenosine myocardial perfusion imaging in patients with left bundle-branch block or electronically paced ventricular rhythm. (Level of Evidence: B) 3. Exercise myocardial perfusion imaging or exercise echocardiography to assess the functional significance of coronary lesions (if not already known) in planning PTCA. (Level of Evidence: B) Class IIb1. Exercise or dobutamine echocardiography in patients with left bundle-branch block. (Level of Evidence: C) 2. Exercise, dipyridamole, adenosine myocardial perfusion imaging, or exercise or dobutamine echocardiography as the initial test in patients who have a normal rest ECG and are not taking digoxin. (Level of Evidence: B) Class III1. Exercise myocardial perfusion imaging in patients with left bundle-branch block. (Level of Evidence: C) 2. Exercise, dipyridamole, adenosine myocardial perfusion imaging, or exercise or dobutamine echocardiography in patients with severe comorbidity likely to limit life expectation or prevent revascularization. (Level of Evidence: C) |
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ESC Guidelines- Risk Stratification according to Exercise Stress ECG in patients Who Can Exercise (DO NOT EDIT)[3]
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Class I1. All patients without significant resting ECG abnormalities undergoing initial evaluation. (Level of Evidence: B) 2. Patients with stable coronary artery disease after a significant change in symptom level. (Level of Evidence: C) Class IIa1. Patients post-revascularization with a significant deterioration in symptomatic status. (Level of Evidence: B) |
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ESC Guidelines- Risk Stratification according to Exercise Stress Imaging (Perfusion or Echocardiography) in patients Who Can Exercise (DO NOT EDIT)[3]
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Class I1. Patients with resting ECG abnormalities, LBBB, more than 1 mm ST depression, paced rhythm, or Wolff Parkinson White syndrome which prevent accurate interpretation of ECG changes during stress. (Level of Evidence: C) 2. Patients with a non-conclusive exercise ECG, but intermediate or high probability of disease. (Level of Evidence: B) Class IIa1. In patients with a deterioration in symptoms post-revascularization. (Level of Evidence: B) 2. As an alternative to exercise ECG in patients where facilities, cost, and personnel resources allow. (Level of Evidence: B) |
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Vote on and Suggest Revisions to the Current Guidelines
Sources
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [3]
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [2]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [4]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [5]
References
- ↑ Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA et al. (1998) Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 97 (6):535-43. PMID: 9494023
- ↑ 2.0 2.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [1] PMID: 10351980
- ↑ 3.0 3.1 3.2 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
- ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758
- ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[3] PMID: 17998462