Stress test: echo vs perfusion imaging 
Author Message
 Stress test: echo vs perfusion imaging

The last few years I have had stress echo tests. They take little time
and are not too expensive (which is important since I have a $5000
deductible so pay out of pocket). This year the cardiologist wants me
to do a perfusion imaging thing that seems to be simailr to a thallium
or cardiolite test. I am suspicious that he is motivated by his
practice having bought the equipment.

Is either of these tests better than the other, or are they just
different in what they tell you? Are there things that an echo can
disclose that a perfusion imaging wouldn't or vice versa? Is there a
good reason to prefer one over the other?



Sun, 13 Feb 2005 10:29:07 GMT
 Stress test: echo vs perfusion imaging

Quote:
> Is either of these tests better than the other, or are they just
> different in what they tell you?

They tell you different things.

Quote:
> Are there things that an echo can
> disclose that a perfusion imaging wouldn't or vice versa?

Yes, definitely.


Sun, 13 Feb 2005 16:29:45 GMT
 Stress test: echo vs perfusion imaging
On Wed, 28 Aug 2002 18:29:45 +1000, "Richard Cavell"

Quote:



>> Is either of these tests better than the other, or are they just
>> different in what they tell you?

>They tell you different things.

>> Are there things that an echo can
>> disclose that a perfusion imaging wouldn't or vice versa?

>Yes, definitely.

OK, what are they and when would you choose one or the other?


Sun, 13 Feb 2005 16:44:12 GMT
 Stress test: echo vs perfusion imaging

Quote:
> OK, what are they and when would you choose one or the other?

To put it simply, an echo tells you about the structure of the heart.  So
you can see the size of the heart (and therefore detect heart failure),
valve disease, etc.

A thallium scan (and cardiolite for that matter) tells you about perfusion
of the heart - so it's more a functional assessment of the coronary
arteries.  You can therefore detect lack of oxygen to part of the heart
muscle.  You cannot detect valve disease or heart failure from a thallium
scan.



Sun, 13 Feb 2005 20:36:01 GMT
 Stress test: echo vs perfusion imaging

Quote:

> The last few years I have had stress echo tests. They take little time
> and are not too expensive (which is important since I have a $5000
> deductible so pay out of pocket). This year the cardiologist wants me
> to do a perfusion imaging thing that seems to be simailr to a thallium
> or cardiolite test. I am suspicious that he is motivated by his
> practice having bought the equipment.

> Is either of these tests better than the other, or are they just
> different in what they tell you?

They are similar in their ability to non-invasively detect severe coronary
blockages.

Quote:
> Are there things that an echo can
> disclose that a perfusion imaging wouldn't or vice versa?

The echo allows visualization of all four chambers of the heart plus
valves while perfusion imaging allows only good visualization of the left
ventricle.

Quote:
> Is there a
> good reason to prefer one over the other?

There can be.  If I were worried about missing severe multivessel coronary
disease where there can be "balanced" ischemia which is sometimes
difficult to detect with perfusion imaging, I would prefer the stress echo
approach.

--
Dr. Andrew B. Chung, MD/PhD
Atlanta Cardiologist
http://www.heartmdphd.com



Mon, 14 Feb 2005 08:15:16 GMT
 Stress test: echo vs perfusion imaging
Consideration:
Medicare reimbur{*filter*}t for nuclear perfusion scan is better than stress
echo... for now.
Stress echo is harder to perform well than nuclear.  The echocardiographer
should be certified by the National Board of Echocardiography (you can check
on their website).
Nuclear is easier to interpret: even first year medical school students can
read the scans. However, make sure they use state of the art scanner with
such features as attenuation corrections, not an ancient second hand mobile
machine.
It all depends on: how good is your echocardiographer versus you nuclear
scanner, or which machine can generate more clinical income.

Rather than talking about the tests themselves, the bigger question is: why
is the test being performed?  The 4 year of Cardiology training can be
summarized as follows:
No symptoms if not diabetic or absence of other risk factor: address lipid,
hs-CRP, and other "chemical factors", as now it is thought that coronary
artery disease is a "generalized disease".  Stress test can be performed to
reasuure the patient and increase clinical revenue.
If some mild symptoms or some risk factors: do stress test, with echo or
nuclear unless the patient is truly low risk.
If severe symptoms: cardiac cath.
Do EBCT or MR angiogram in special circumstances, if available.

Technical points:
Both echo and nuclear are horrible with RV wall motion and function: for
that you need a cardiac MRI.  But for most patients the RV is irrelevant.
The risk of missing balanced ischemia can be minimized by using gated wall
motion analysis and paying attention to LV chamber size with stress.

quantmann



Quote:

> > The last few years I have had stress echo tests. They take little time
> > and are not too expensive (which is important since I have a $5000
> > deductible so pay out of pocket). This year the cardiologist wants me
> > to do a perfusion imaging thing that seems to be simailr to a thallium
> > or cardiolite test. I am suspicious that he is motivated by his
> > practice having bought the equipment.

> > Is either of these tests better than the other, or are they just
> > different in what they tell you?

> They are similar in their ability to non-invasively detect severe coronary
> blockages.

> > Are there things that an echo can
> > disclose that a perfusion imaging wouldn't or vice versa?

> The echo allows visualization of all four chambers of the heart plus
> valves while perfusion imaging allows only good visualization of the left
> ventricle.

> > Is there a
> > good reason to prefer one over the other?

> There can be.  If I were worried about missing severe multivessel coronary
> disease where there can be "balanced" ischemia which is sometimes
> difficult to detect with perfusion imaging, I would prefer the stress echo
> approach.

> --
> Dr. Andrew B. Chung, MD/PhD
> Atlanta Cardiologist
> http://www.***.com/



Tue, 22 Feb 2005 11:22:26 GMT
 Stress test: echo vs perfusion imaging

Quote:

>Is either of these tests better than the other, or are they just
>different in what they tell you? Are there things that an echo can
>disclose that a perfusion imaging wouldn't or vice versa? Is there a
>good reason to prefer one over the other?

It seems that some surgeries require having the patient undergo a Thallium
Stress Test first.

I assume that the surgeon believes that it's safer to know about any heart
condition revealed by the test before committing to the surgery. Is this
reasonable?



Sun, 06 Mar 2005 10:31:46 GMT
 Stress test: echo vs perfusion imaging

Quote:



> >Is either of these tests better than the other, or are they just
> >different in what they tell you? Are there things that an echo can
> >disclose that a perfusion imaging wouldn't or vice versa? Is there a
> >good reason to prefer one over the other?

> It seems that some surgeries require having the patient undergo a Thallium
> Stress Test first.

> I assume that the surgeon believes that it's safer to know about any heart
> condition revealed by the test before committing to the surgery. Is this
> reasonable?

Yes, if there are reasons to suspect a person is at intermediate to high risk
for having an underlying heart condition.

--
Dr. Andrew B. Chung, MD/PhD
Atlanta Cardiologist
http://www.heartmdphd.com



Sun, 06 Mar 2005 12:06:14 GMT
 Stress test: echo vs perfusion imaging


Quote:

>> It seems that some surgeries require having the patient undergo a Thallium
>> Stress Test first.

>> I assume that the surgeon believes that it's safer to know about any heart
>> condition revealed by the test before committing to the surgery. Is this
>> reasonable?

>Yes, if there are reasons to suspect a person is at intermediate to high risk
>for having an underlying heart condition.

Another reason might be to ask the patient to acknowledge the risk and
accept responsibility before committing to the surgery.


Wed, 09 Mar 2005 09:51:57 GMT
 Stress test: echo vs perfusion imaging


Quote:



>>> It seems that some surgeries require having the patient undergo a Thallium
>>> Stress Test first.

>>> I assume that the surgeon believes that it's safer to know about any heart
>>> condition revealed by the test before committing to the surgery. Is this
>>> reasonable?

>>Yes, if there are reasons to suspect a person is at intermediate to high risk
>>for having an underlying heart condition.

>Another reason might be to ask the patient to acknowledge the risk and
>accept responsibility before committing to the surgery.

You are asked to do this prior to any surgical procedure.


Fri, 11 Mar 2005 03:27:43 GMT
 
 [ 10 post ] 

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