View source for Chronic stable angina risk stratification cardiac stress imaging in patients who are unable to exercise

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{{Chronic stable angina}}

{{CMG}}; '''Associate Editor-in-Chief:''' [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan, M.B.B.S.]]

==Overview==
One of the '''negative prognostic factor''' is the patients inability to perform exercise test. In patients who cannot exercise, depending on specific patient factors like [[heart rate]], [[blood pressure]], the presence or absence of [[bronchospasm]], the presence of [[left bundle-branch block]] , and [[ventricular arrhythmias]] suitable type of [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|pharmacologic stress test]] <ref name="pmid8222748">Verani MS (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8222748 Pharmacologic stress myocardial perfusion imaging.] ''Curr Probl Cardiol'' 18 (8):481-525. PMID: [http://pubmed.gov/8222748 8222748]</ref> <ref name="pmid8989683">Leppo JA (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8989683 Comparison of pharmacologic stress agents.] ''J Nucl Cardiol'' 3 (6 Pt 2):S22-6. PMID: [http://pubmed.gov/8989683 8989683]</ref> is advised. Pharmacological agents such as [[dobutamine]] induces stress by increasing cardiac contractility and [[heart rate]] while vasodilators such as [[dipyridamole]] or [[adenosine]] increase the overall coronary blood flow and produce regional differences in perfusion <ref name="pmid7916274">Beleslin BD, Ostojic M, Stepanovic J, Djordjevic-Dikic A, Stojkovic S, Nedeljkovic M et al. (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7916274 Stress echocardiography in the detection of myocardial ischemia. Head-to-head comparison of exercise, dobutamine, and dipyridamole tests.] ''Circulation'' 90 (3):1168-76. PMID: [http://pubmed.gov/7916274 7916274]</ref> <ref name="pmid9593561">Wagdy HM, Hodge D, Christian TF, Miller TD, Gibbons RJ (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9593561 Prognostic value of vasodilator myocardial perfusion imaging in patients with left bundle-branch block.] ''Circulation'' 97 (16):1563-70. PMID: [http://pubmed.gov/9593561 9593561]</ref> <ref name="pmid9544659">Nigam A, Humen DP (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9544659 Prognostic value of myocardial perfusion imaging with exercise and/or dipyridamole hyperemia in patients with preexisting left bundle branch block.] ''J Nucl Med'' 39 (4):579-81. PMID: [http://pubmed.gov/9544659 9544659]</ref>. The presence of a perfusion defect as observed with dipyridamole-thallium-201 is an independent prognostic factor <ref name="pmid9715986">Gil VM, Almeida M, Ventosa A, Ferreira J, Aguiar C, Calqueiro J et al. (1998)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9715986 Prognosis in patients with left bundle branch block and normal dipyridamole thallium-201 scintigraphy.] ''J Nucl Cardiol'' 5 (4):414-7. PMID:[http://pubmed.gov/9715986 9715986]</ref>. Dobutamine induced ventricular wall motion abnormalities as seen on echocardiography is associated with myocardial viability and [[restenosis]] <ref name="pmid8613604">Shaw LJ, Eagle KA, Gersh BJ, Miller DD (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8613604 Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery.] ''J Am Coll Cardiol'' 27 (4):787-98. PMID: [http://pubmed.gov/8613604 8613604]</ref> <ref name="pmid8185419">Madu EC, Ahmar W, Arthur J, Fraker TD (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8185419 Clinical utility of digital dobutamine stress echocardiography in the noninvasive evaluation of coronary artery disease.] ''Arch Intern Med'' 154 (10):1065-72. PMID: [http://pubmed.gov/8185419 8185419]</ref>.

==ACC / AHA Guidelines- Cardiac Stress Imaging as the Initial Test for Risk Stratification of Patients With Chronic Stable Angina Who Are Unable to Exercise (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 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. PMID: [http://pubmed.gov/10351980 10351980]</ref>==

{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|Dipyridamole or adenosine]] myocardial perfusion imaging or [[dobutamine]] echocardiography to identify the extent, severity, and location of [[ischemia]] in patients who do not have [[left bundle-branch block]] or electronically paced ventricular rhythm. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|Dipyridamole or adenosine]] myocardial perfusion imaging in patients with [[left bundle-branch block]] or electronically paced ventricular rhythm. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|Dipyridamole or adenosine]] myocardial perfusion imaging or [[dobutamine]] echocardiography to assess the functional significance of coronary lesions (if not already known) in planning [[PTCA]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|} 

{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]

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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Dobutamine]] echocardiography in patients with [[left bundle-branch block]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]

|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|Dipyridamole or adenosine]] myocardial perfusion imaging or [[dobutamine]] echocardiography in patients with severe comorbidity likely to limit life expectation or prevent [[Chronic stable angina revascularization|revascularization]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==Vote on and Suggest Revisions to the Current Guidelines==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]

==Guidelines Resources==
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 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. PMID: [http://pubmed.gov/10351980 10351980]</ref>

*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=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. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>

*The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 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. PMID: [http://pubmed.gov/12515758 12515758]</ref>

*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</ref>

==References==
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