Diagnostic Accuracy of Common Stress Testing Modalities in Patients Without Known Ischemic Heart Disease
| Test Type | Sensitivity | Specificity | Advantages | Disadvantages |
|---|
| ECG | | Exercise | 61% | 70%–77% | - Easy to perform
- Inexpensive
| - Less diagnostic accuracy, especially in women
- No viability assessment
| | Pharmacologic | — | — | | Echocardiography | | Exercise | 70%–85% | 77%–89% | - Gather other important information on diastolic function, valvular disorders, and pulmonary pressures
- Can assess viability with pharmacologic stress
| - Limited by image quality
- Diagnostic accuracy reduced with resting wall motion abnormalities
| | Pharmacologic (dobutamine) | 85%–90% | 79%–90% | | Nuclear Perfusion Imaging | | Exercise | 82%–88% | 70%–88% | - More sensitive for small areas of ischemia/infarct
- Very accurate ejection fraction assessment
- Easy to compare to prior studies
| - Significant radiation
- May underestimate severe balanced ischemia
- No other valve or other structural information
- Viability may require separate testing
| | Pharmacologic (adenosine, regadenoson, or dobutamine) | 82%–91% | 75%–90% | | Cardiac MRI | | Exercise | — | — | - Excellent assessment of viability
- Anatomic detail of heart and great vessels superb
| - Expensive
- Requires closed MRI
- Exercise option not typically available
| | Pharmacologica | 91% | 81% |
|
All diagnostic accuracies unadjusted for referral bias.1,2
a Vasodilator stress only; dobutamine has sensitivity of 83% and specificity of 86%.