Comparison between SE, myocardial scintigraphy, and CCTA
| Aspect | SE | Myocardial scintigraphy | CCTA |
|---|---|---|---|
| Method | Evaluates cardiac function under stress using exercise or pharmacologic agents | Assesses blood flow to heart muscle using radiopharmaceuticals, combined with stress | Provides detailed anatomical images of the coronary arteries using CT technology |
| Population | Patients with moderate likelihood of CAD; able to exercise; evaluation of valvular disease or left ventricular dysfunction | Patients with suspected CAD, particularly those who cannot exercise or where functional information about myocardial perfusion is required | Patients with low/intermediate likelihood of CAD; unclear outcomes from other stress tests; need to assess coronary anatomy |
| Types/Procedure | Treadmill, supine ergometer, handgrip, six-minute walk test, dipyridamole, and dobutamine | Imaging includes rest and stress phases using PET or SPECT with radiopharmaceuticals. | Imaging includes pre-scan medications, contrast injection, and ECG-triggered scans. |
| Applications | Diagnosis of IHD, valvular disease, heart failure, cardiomyopathies | Diagnosis of cardiac ischemia, assessment of CFR, identification of hibernating myocardium | Exclusion of CAD in symptomatic patients, early identification of nonobstructive CAD |
| Imaging techniques | Real-time echocardiographic images during or immediately after stress | PET and SPECT imaging to visualize myocardial perfusion and viability | High-resolution CT images with optional FFR-CT for functional assessment |
| Safety | Generally safe with low risk; requires monitoring and emergency equipment | Low risk, with concerns primarily related to radiation and allergic reactions; contraindications for specific patient groups | Risks include radiation and contrast reactions; low-dose protocols are used. |
| Contraindications | Acute coronary syndrome, severe heart failure, severe hypertension, etc. | Unstable angina, severe heart failure, severe pulmonary hypertension | Severe renal insufficiency, uncontrolled hypertension, and contrast allergies |
| Advantages |
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| Limitations |
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| Indications | Ideal for patients who can exercise; used for functional cardiac assessments. | Ideal for evaluating myocardial perfusion, particularly when anatomical insights are needed. | Ideal for coronary anatomy evaluation and ruling out CAD |
| Sensitivity | 70–85% | PET: 90–95%SPECT: 85% | 95–99% |
| Specificity | 77–90% | PET: 80–90%SPECT: 70% | 64–85% |
| Wait times | Generally short, as SE is widely available. | Moderate to long due to limited availability, particularly for PET, which requires specialized facilities | Moderate, depending on scanner availability and patient preparation (e.g., heart rate control) |
| Technical details for the technician | Optimal transducer placement and continuous monitoring during stress rely on operator experience. | Precise radiotracer injection timing; correct patient positioning to avoid artifacts; longer post-processing time for PET | Requires heart rate control (beta-blockers); timely administration of contrast; avoiding artifacts |
| Details to consider for the patient | Ability to exercise or tolerate pharmacological stress | Radiation exposure, especially with SPECT; possible claustrophobia during scan; need for radiotracer injection | Kidney function (for contrast use); potential allergies to contrast; preparation to slow heart rate |
| Unique benefits | Real-time, non-invasive, and assesses the heart’s response to physiological stress | Excellent for detecting ischemia and assessing myocardial viability | High accuracy in visualizing coronary arteries and identifying significant lesions |
SE: stress echocardiography; CCTA: coronary computed tomography angiography; CT: computed tomography; CAD: coronary artery disease; PET: positron emission tomography; SPECT: single-photon emission CT; ECG: electrocardiogram; IHD: ischemic heart disease; CFR: coronary flow reserve; FFR-CT: fractional flow reserve CT
