Diagnostic Testing for Cardiovascular Diseases

  • Carl J. Lavie
  • Franz H. Messerli
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 135)


Despite new statistics indicating declining mortality trends from cardiovascular diseases in the United States, data from the American Heart Association (AHA) Task Force indicate that with aging of the population, the absolute incidence and prevalence of cardiovascular diseases will actually increase during the next two decades, total deaths will increase by nearly 20%, and total cost to society (adjusted for inflation) will increase by 30% [1,2]. Therefore, the diagnosis of cardiovascular diseases in the elderly will remain a major part of the clinical practice of general internists, family physicians, and cardiologists. Although invasive testing usually is the “gold standard” for identifying cardiovascular diseases, physicians often desire less invasive and less expensive procedures with fewer risks in order to diagnose disease and follow patients with known disease. Technological advances have made available a wider array of clinical studies which, if used appropriately, add to our ability to recognize and treat cardiovascular diseases in the elderly population.


Myocardial Perfusion Imaging Digital Subtraction Angiography Radionuclide Angiography Pretest Likelihood Thallium Scintigraphy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Frye RL, Higgins MW, Beller GA, et al. 1988. Task Force III: major demographic and epidemiologic trends affecting adult cardiology. J Am Coll Cardiol 12:840–846.PubMedCrossRefGoogle Scholar
  2. 2.
    Lavie CJ, Ventura HO, and Murgo JP. 1991. Assessment of stable ischemic heart disease: which tests are best for which patients? Postgrad Med 89:44–61.PubMedGoogle Scholar
  3. 3.
    Epstein SE. 1980. Implications of probability analysis on the strategy used for noninvasive detection of coronary artery disease: role of single or combined use of exercise electrocardiographic testing, radionuclide cineangiography and myocardial perfusion imaging. Am J Cardiol 46:491–499.PubMedCrossRefGoogle Scholar
  4. 4.
    Lavie CJ, Squires RW, and Gau GT. 1987. Prevention of cardiovascular disease: of what value are risk factor modification, exercise, fish consumption, and aspirin therapy? Postgrad Med 81:52–72.PubMedGoogle Scholar
  5. 5.
    Lavie CJ, Gau GT, Squires RW, et al. 1988. Management of lipids in primary and secondary prevention of cardiovascular diseases. Mayo Clin Proc 63:605–621.PubMedCrossRefGoogle Scholar
  6. 6.
    Lavie CJ, O’Keefe JH, Blonde L, et al. 1990. High-density lipoprotein cholesterol: recommendations for routine testing and treatment. Postgrad Med 87:36–51.PubMedGoogle Scholar
  7. 7.
    Schlant RC, Blomquist CG, Brandenburg RO, et al. 1986. Guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association on Assessment of Cardiovascular Procedures (Subcommittee on Exercise Testing). J Am Coll Cardiol 8:725–738.CrossRefGoogle Scholar
  8. 8.
    Kligfield P, Ameisen O, and Okin PM. 1989. Heart rate adjustment of ST segment depression for improved detection of coronary artery disease. Circulation 79:245–255.PubMedCrossRefGoogle Scholar
  9. 9.
    Okin PM, Kligfield P, Milner MR, et al. 1988. Heart rate adjustment of ST-segment depression for reduction of false positive electrocardiographic responses to exercise in asymptomatic men screened for coronary artery disease. Am J Cardiol 62:1043–1047.PubMedCrossRefGoogle Scholar
  10. 10.
    Rodeheffer RJ, Gerstenblith G, Becker LC, et al. 1984. Exercise cardiac output is maintained with advancing age in healthy human subjects. Cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation 69:203–213.PubMedCrossRefGoogle Scholar
  11. 11.
    Gibbons RJ, Fyke FE 3d, Clements IP, et al. 1988. Noninvasive identification of severe coronary artery disease using exercise radionuclide angiography. J Am Coll Cardiol 11: 28–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaul S, Lilly DR, Gascho JA, et al. 1988. Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization. Circulation 77:745–748.PubMedCrossRefGoogle Scholar
  13. 13.
    Kaul S, Finkelstein DM, Homma S, et al. 1988. Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization. J Am Coll Cardiol 12:25–34.PubMedCrossRefGoogle Scholar
  14. 14.
    Lavie CJ, Gibbons RJ, Zinsmiester, et al. 1991. Interpreting results of exercise studies after acute myocardial infarction altered by thrombolytic therapy, coronary angioplasty, or bypass. Am J Cardiol 67:116–120.PubMedCrossRefGoogle Scholar
  15. 15.
    Sinusas AJ, Watson DD, Cannon JM Jr, et al. 1989. Effect of ischemia and postischemic dysfunction on myocardial uptake of technetium-99m-labeled methoxyisobutyl isonitrile and thallium-201. J Am Coll Cardiol 14:1785–1793.PubMedCrossRefGoogle Scholar
  16. 16.
    Lavie CJ and Gersh BJ. 1990. Acute myocardial infarction: initial manifestations, management, and prognosis. Mayo Clin Proc 65:531–548.PubMedCrossRefGoogle Scholar
  17. 17.
    Ranhosky A, Kempthorne-Rawson J, and the Intravenous Dipyridamole Thallium Imaging Study Group. 1990. The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Circulation 81:1205–1209.PubMedCrossRefGoogle Scholar
  18. 18.
    Eagle KA, Coley CM, Newell JB, et al. 1989. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 110:859–866.PubMedGoogle Scholar
  19. 19.
    Lapeyre AC, Gibbons RJ, and Forstrom IA. 1988. Prediction of cardiac complications of non-cardiac surgery by intravenous dipyridamole thallium tomography (abstract). J Nucl Med 29:838.Google Scholar
  20. 20.
    Verani MS. 1991. Adenosine thallium 201 myocardial perfusion scintigraphy. Am Heart J 122:269–278.PubMedCrossRefGoogle Scholar
  21. 21.
    Armstrong WF. 1988. Exercise echocardiography: ready, willing and able (editorial). J Am Coll Cardiol 11:1359–1361.PubMedCrossRefGoogle Scholar
  22. 22.
    Pirelli S, Danzi GB, Alberti A, et al. 1991. Comparison of usefulness of high-dose dipyridamole echocardiography and exercise electrocardiography for detection of asymptomatic restenosis after coronary angioplasty. Am J Cardiol 67:1335–1338.PubMedCrossRefGoogle Scholar
  23. 23.
    Picano E, Pirelli S, Marzilli M, et al. 1989. Usefulness of high-dose dipyridamole echocardiography test in coronary angioplasty. Circulation 80:807–815.PubMedCrossRefGoogle Scholar
  24. 24.
    Picano E, Lattanzi F, Masini M, et al. 1986. High dose dipyridamole echocardiography test in effort angina pectoris. J Am Coll Cardiol 8:848–854.PubMedCrossRefGoogle Scholar
  25. 25.
    Picano E, Pirelli S, Orlandini A, et al. in press. The safety of high dose intravenous dipyridamole-echocardiography test. J Am Coll Cardiol.Google Scholar
  26. 26.
    Picano E, Lattanzi F, Orlandini A, et al. 1991. Stress echocardiography and the human factor: the importance of being expert. J Am Coll Cardiol 17:666–669.PubMedCrossRefGoogle Scholar
  27. 27.
    Cohen JL, Greene TO, Ottenweller J, et al. 1991. Dobutamine digital echocardiography for detecting coronary artery disease. Am J Cardiol 67:1311–1318.PubMedCrossRefGoogle Scholar
  28. 28.
    Slutsky R, Watkins J, Peterson K, et al. 1981. The response of left ventricular function and size to atrial pacing, volume loading, and afterload stress in patients with coronary artery disease. Circulation 63:864–870.PubMedCrossRefGoogle Scholar
  29. 29.
    Feldman MD, McKay RG, Gervin EV, et al. 1985. The noninvasive thoracic pacing tachycardia test: hemodynamic responses (abstract). Circulation 72:20.Google Scholar
  30. 30.
    Brown BG, Josephson MA, Peterson MA, et al. 1981. Intravenous dipyridamole combined with isometric handgrip for near maximal acute increase in coronary flow in patients with coronary artery disease. Am J Cardiol 48:1077–1085.PubMedCrossRefGoogle Scholar
  31. 31.
    Bodenheimer MM, Banka VA, Fooshie CM, et al. 1978. Detection of coronary heart disease using radionuclide determined regional ejection fraction at rest and during handgrip: correlation with coronary angiography. Circulation 58:640–648.PubMedCrossRefGoogle Scholar
  32. 32.
    Peter CA, and Jones RH. 1980. Effect of isometric handgrip and dynamic exercise in left ventricular function. J Nucl Med 21:1131–1138.PubMedGoogle Scholar
  33. 33.
    Kennedy JW. 1982. Complications associated with cardiac catheterization and angiography. Cathet Cardiovasc Diagn 8:5–11.PubMedCrossRefGoogle Scholar
  34. 34.
    Rose DM, Gelbfish J, Jocobowitz IJ, et al. 1985. Analysis of morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery. Am Heart J 110:341–346.PubMedCrossRefGoogle Scholar
  35. 35.
    Raizner AE, Hust RG, Lewis JM, et al. 1986. Transluminal coronary angioplasty in the elderly. Am J Cardiol 57:29–32.PubMedCrossRefGoogle Scholar
  36. 36.
    Goldman R. 1979. Decline in organ functioning with aging. In I Rossman (ed), Clinical Geriatrics, 2nd ed. Philadelphia: J.B. Lippincott, pp 23–59.Google Scholar
  37. 37.
    Krumlovsky FA, Simon N, Santhanam S, et al. 1978. Acute renal failure: association with administration of radiographic contrast material. JAMA 239:125–127.PubMedCrossRefGoogle Scholar
  38. 38.
    Bryd L and Sherman RL. 1979. Radiocontrast-induced acute renal failure. A clinical and pathophysiologic review. Medicine 58:270–279.CrossRefGoogle Scholar
  39. 39.
    Cochran ST, Wong WS, and Roe DJ. 1983. Predicting angiography-induced acute renal impairment: a clinical risk model. AJR 141:1027–1033.PubMedGoogle Scholar
  40. 40.
    Taliercio CP, Vliestra RE, Fisher LD, et al. 1986. Risks for renal dysfunction with cardiac angiography. Ann Intern Med 104:501–504.PubMedGoogle Scholar
  41. 41.
    Brandenbury RO. 1981No more routine catheterization for valvular heart disease? N Engl J Med 305:1277–1288.CrossRefGoogle Scholar
  42. 42.
    St John Sutton MG, St John Sutton M, Oldershaw P, et al. 1981. Valve replacement without preoperative cardiac catheterization. N Engl J Med 305:1233–1238.PubMedCrossRefGoogle Scholar
  43. 43.
    Richardson JV, Kouchoukos NT, Wright JO III, et al. 1979. Combined aortic valve replacement and myocardial revascularization: result in 220 patients. Circulation 59:75–81.PubMedCrossRefGoogle Scholar
  44. 44.
    Kirblen JW and Kouchoukos NT. 1981. Aortic valve replacement without myocardial revascularization. Circulation 63:252–253.CrossRefGoogle Scholar
  45. 45.
    Borow RO, Kent KM, Roseng DR, et al. 1981. Aortic valve replacement without myocardial revascularization in patients with combined aortic valvular and coronary artery disease. Circulation 63:243–251.CrossRefGoogle Scholar
  46. 46.
    Teply JF, Grunkemeier GL, and Starr A. 1981. A cardiac valve replacement in patients over 75 years of age. Thorac Cardiovasc Surg 29:47–50.PubMedCrossRefGoogle Scholar
  47. 47.
    Murphy ES, Lawson RM, Starr A, et al. 1981. Severe aortic stenosis in patients 60 years of age and older: left ventricular function and 10-year survival after valve replacement. Circulation 2 (Suppl II):II–184–II–188.Google Scholar
  48. 48.
    Jamieson WR, Dooner J, Munro AI, et al. 1981. Cardiac valve replacement in the elderly: a review of 320 cases. Circulation 2 (Suppl II):II–177–II–183.Google Scholar
  49. 49.
    Ballard DJ, Khandheria BK, Tajik AJ, et al. 1989. A population-based study of echocardiography: time trends in utilization and diagnostic profile of an evolving technology, 1975–1987. Int J Technol Assess Health Care 5:249–261.PubMedCrossRefGoogle Scholar
  50. 50.
    Lavie CJ, Hebert K, and Cassidy M. in press. Prevalence and severity of Doppler-detected valvular regurgitation and estimation of right sided cardiac pressures in patients with normal 2-dimensional echocardiograms. Chest.Google Scholar
  51. 51.
    Lavie CJ, Khandheria BK, Seward JB, et al. 1989. Factors associated with the recommendation for endocarditis prophylaxis in mitral valve prolapse. JAMA 262:3308–3312.PubMedCrossRefGoogle Scholar
  52. 52.
    Ballard DJ, Lavie CJ, Taylor CL, et al. 1988. Impact of Doppler echocardiography detected mitral regurgitation on endocarditis prophylaxis recommendations: a population-based study (abstract). Circulation 78 (Suppl II):11–585.Google Scholar
  53. 53.
    Lavie CJ, Khandheria B, Taylor C, et al. 1990. Age bias in endocarditis prophylaxis recommendations: a review of population-based studies (abstract). J Am Geriatr Soc 38:11A.Google Scholar
  54. 54.
    Cebal RD and Paulus RA. 1986. The failure of intravenous digital subtraction angiography in replacing carotid anteriography. Ann Intern Med 104:572–574.Google Scholar
  55. 55.
    Aaron JO, Hesselink JR, Oot R, et al. 1984. Complication of intravenous DSA performed for carotid artery disease: a prospective study. Radiology 155:675–678.Google Scholar
  56. 56.
    Crocker EF Jr, Tutton RH, and Bowen JC. 1986. The role of intravenous digital subtraction angiography in the evaluation of extracranial carotid artery disease: can the decision for carotid artery surgery be made solely on the basis of its findings? J Vasc Surg 4:157–163.PubMedGoogle Scholar
  57. 57.
    Hoffman MG, Gomes AS, and Pais SO. 1984. Limitations in the interpretation of intravenous carotid digital subtraction angiography. AJR 142:261–264.PubMedGoogle Scholar
  58. 58.
    Glover JL, Bendick PJ, Jackson VP, et al. 1984. Duplex sonography, digital subtraction angiography, and conventional angiography in assessing carotid atherosclerosis. Arch Surg 119:664–669.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1993

Authors and Affiliations

  • Carl J. Lavie
  • Franz H. Messerli

There are no affiliations available

Personalised recommendations