Perspectivas sobre la utilización de las modalidades de imagen de estrés en la valoración inicial de la cardiopatía isquémica

A variety of noninvasive tests are available to clinicians for the evaluation of patients in whom ischemic heart disease is suspected because of chest pain, clinical antecedents, or a combination of the two. Although all tests in general help to varying degrees to refine (by inclusion or exclusion) the diagnosis in a given patient, there are undoubtedly important differences between tests regarding their scope and diagnostic accuracy in general, and with respect to certain groups of patients in particular. Because of this, and in view of the obvious economic implications, the topic merits critical review before the information obtained from these tests is used in patient management. This review is not intended to cover all features that argue for or against all currently available noninvasive tests for ischemic heart disease, but to place into perspective the importance of the clinical assessment of the patient in the light of the results of testing, and to obtain a more rational idea of their usefulness. Despite the risk of excluding certain material of interest, excellent techniques such as magnetic resonance imaging will not be covered in the review, only because they have not yet been included in meta-analyses. Emphasis on the Bayesian rationale or paradigm, together with discussion of recent meta-analyses, offers a balanced perspective of the use and possible misuse of these diagnostic tests, and of their clinical and economic implications.