Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

Stress echocardiography and myocardial perfusion imaging are commonly used noninvasive imaging modalities for the evaluation of ischaemic heart disease. Both modalities have proved clinically useful in the entire spectrum of coronary artery disease. Both techniques can detect coronary artery disease and provide prognostic information. Both techniques can identify lowrisk and high-risk subsets among patients with known or suspected coronary artery disease and thus guide patient management decisions. In patients with acute myocardial infarction, both techniques have been used to identify residual viable tissue and predict improvement of function over time. In patients with chronic ischaemic left ventricular (LV) dysfunction, viability assessment with either modality can be used to predict improvement of function after revascularisation and thus guide patient treatment. Hence, the use of noninvasive cardiac imaging can help guide management and potentially reduce healthcare costs. The question remains what is the optimal noninvasive cardiac imaging method in which setting? This article evaluates the value of the two modalities in: (1) the detection of coronary artery disease, (2) the prognosis of coronary artery disease in patients with known or suspected coronary artery disease, (3) prediction of functional recovery following acute myocardial infarction and (4) prediction of functional recovery after revascularisation in patients with chronic ischaemic LV dysfunction. To provide the most objective information, only direct comparative studies on stress echocardiography and perfusion imaging in the same patients are included and pooled analysis of the data was performed.