Common indications for stress testing and coronary computed tomography angiography
| Assessment for coronary artery disease Angina or anginal equivalent symptoms and negative cardiac enzymes Atypical symptoms in patients with diabetes or with high probability of diabetes New diagnosis of cardiomyopathy (to define whether the cause is ischemic or nonischemic) New or increasing heart failure symptoms despite adherence to medical therapy Re-evaluation of known heart failure (systolic or diastolic) in patients with a change in clinical status without a clear precipitating change in medication or diet Arrhythmias such as ventricular tachycardia or atrial fibrillation (to exclude ischemia as the cause) or new left bundle-branch block To exclude severe ischemia prior to noncardiac surgery in those with increased coronary artery disease risks, angina symptoms, or poor exercise capacity (< 4 metabolic equivalents) To define presence or absence of ischemia in those with moderate coronary stenosis (stress test or fractional flow reserve-computed tomography) Evaluation of anomalous coronary arteries |
| Stress testing for indications other than coronary artery disease assessment Valve assessment Mitral valve stenosis or regurgitation severity (exercise stress echocardiography) Low-flow low gradient aortic stenosis (dobutamine stress echocardiography) Exercise-induced pulmonary hypertension or diastolic dysfunction (exercise stress echocardiography) Hypertrophic cardiomyopathy to demonstrate provocable left ventricular outflow tract obstruction (exercise stress echocardiography) Exercise-induced arrhythmia or chronotropic incompetence (exercise stress echocardiography) To define cardiopulmonary disease and aerobic exercise capacity (metabolic stress test) |
Data from references 3 and 7–10.