Assessment of Patients with Suspected Coronary Artery Disease

  • Richard T. RuffinJr
  • Gary V. Heller
  • Gary V. Heller


Cardiovascular disease continues to be the single greatest cause of morbidity and mortality for men and women in the United States despite the reduction in mortality that has been seen over recent years. This underscores the importance of early identification of patients most at risk for the development of coronary artery disease. Stress myocardial perfusion imaging has been validated as an efficient non-invasive modality in the detection of coronary artery disease (CAD). Although extremely useful, the efficacy of MPI is dependent on appropriate utilization and testing should be performed when the results will significantly affect clinical management. While the evaluation of patients with no known CAD requires careful selection, the identification of “at risk” patients provides important management data.


Coronary Artery Disease Myocardial Perfusion Imaging Asymptomatic Patient Coronary Artery Calcium Framingham Risk Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Heller GV, Hendel RC. Nuclear cardiology: practical applications. New York: McGraw-Hill; 2004. p. 157–73.Google Scholar
  2. 2.
    D’Agostino RB, Grundy S, et al. Validation of the Framingham coronary heart disease: prediction scores results of a multiple ethnic groups investigation. JAMA. 2001;286:180–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol. 2009;53:2201–29.PubMedCrossRefGoogle Scholar
  4. 4.
    Hendel RC, Abbott BG, et al. The role of radionuclide myocardial perfusion imaging for asymptomatic individuals. ASNC information statement. J Nucl Cardiol. 2011;18(1):3–15.PubMedCrossRefGoogle Scholar
  5. 5.
    Chaitman BR. Exercise stress testing. In: Libby P, Bonow RO, Mann DL, Zipes DP, editors. Libby: Braunwald’s heart disease: a textbook of cardiovascular medicine. 8th ed. Philadelphia: Saunders; 2008: chap 13.Google Scholar
  6. 6.
    Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 1997;96(1):345–54.PubMedCrossRefGoogle Scholar
  7. 7.
    Wackers FJ, Chyun DA, Young LH, Heller GV, Iskandrian AE, et al. Resolution of asymptomatic myocardial ischemia in patients with type 2 diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. Diabetes Care. 2004;27:1954–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Taillefer R, DePuey GE, Udelson JE, Beller GA, Latour Y, Reeves F. Comparative diagnostic accuracy of TI-201 and Tc-99m sestamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol. 1997;29:69–77.PubMedCrossRefGoogle Scholar
  9. 9.
    Singh B, Bateman TM, Case JA, Heller GV. Attenuation artifact, attenuation correction, and the future of myocardial perfusion SPECT. J Nucl Cardiol. 2007;14:153–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Udelson JE, Beshansky JR, Ballin DS, Feldman JA, Griffith JL, Heller GV, Hendel RC, Pope JH, Ruthazer R, Spiegler EJ, Woolard RH, Handler J, Selker HP. Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia. JAMA. 2002;288:2693–700.PubMedCrossRefGoogle Scholar
  11. 11.
    Duncan BH, Heller GV. Acute rest myocardial perfusion imaging in the evaluation of patients with chest pain syndromes. Am Coll Cardiol J Rev. 1999;8:52–6.Google Scholar
  12. 12.
    Gibson PB, Demus D, Noto R, Hudson W, Johnson LL. Low event rate for stress-only perfusion imaging in patients evaluated for chest pain. J Am Coll Cardiol. 2002;39:999–1004.PubMedCrossRefGoogle Scholar
  13. 13.
    Heller GV, Stowers SA, Hendel RC, Herman SD, Daher E, Ahlberg AW, Baron JM, Mendes DeLeon CF, Wackers FJ. Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms. J Am Coll Cardiol. 1998;31:1011–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Richard T. RuffinJr
    • 1
  • Gary V. Heller
    • 2
  • Gary V. Heller
    • 3
  1. 1.Cardiology Hospitalist, Division of CardiologyHartford HospitalHartfordUSA
  2. 2.University of Connecticut School of MedicineFarmingtonUSA
  3. 3.Intersocietal Accreditation CommissionEllicott CityUSA

Personalised recommendations