| Modality |
Measures |
Sensitivity 40-50%1
(Partial Occlusion) |
Sensitivity 50-70%1
(Partial Occlusion) |
Sensitivity >70%1
(Stenosis) |
Specificity |
Time Required |
Objective / Quantitative |
Comparison Reference |
| Angiogram |
Coronary Anatomy |
Gold Standard |
Gold Standard |
Gold Standard |
85-90%> |
Long prep and testing time |
No |
The "Gold Standard", coronary angiography,
was able to detect atheromas only 3.0% of the time in
17% of those under 20 years, 37% of those aged 20 to
29, and 60% of those aged 30 to 39 years. This means
that angiography results were negative in 97% of these
populations when they in fact had atheromas in their
coronary arteries.
|
EST2/EKG
Typical EKG |
Physical Stress induced EKG Changes |
N/A |
N/A |
68% |
77% |
30-40 minutes |
No |
All Exercise Stress Testing modalities share relatively
low sensitivity - the outlier, stress echo testing,
requires quick and careful work by the technician in
order to achieve usable results.
|
EST2/EKG
True EKG |
Physical Stress induced EKG Changes |
N/A |
N/A |
45% |
85% |
30-40 minutes |
No |
| EST2/Echo |
Physical Stress induced Echo Changes |
N/A |
N/A |
31-90% + |
46-100% |
30-40 minutes
Technically Demanding |
No |
| 12 Lead Resting EKG |
Vectorized Time Domain and Voltage (in 2D) |
N/A |
20% CAD (1) |
20% CAD
52% MI |
97% CAD
9% MI |
Minimal lag time |
No |
Resting ECG Analysis, including 12-lead ECG,
typically has significantly less sensitivity in
detecting ischemia. Clinical studies report a wide
range for sensitivity for Acute Myocardial Infarction
(AMI), and typically even less for hemodynamically
significant CAD Ischemia.
|
| Troponin |
Heart Muscle Enzymes |
N/A |
N/A |
N/A |
N/A |
~ 6 hours |
Yes |
Even in the event of myocardial infarction Troponin markers
become positive only after a significant lag time.
|
| MRI-Angiogram3 |
Coronary Anatomy |
N/A |
74% |
54% |
75%
(Patient Analysis) |
A few minutes |
Yes |
Expensive and not universally available.
13-18% noise rejections. |
| CT3 |
Coronary Anatomy |
N/A |
82-92% |
82% |
79%
(Patient Analysis) |
A few minutes |
Yes |
Expensive and not universally available; Involves
radiation exposure (~12.3 mSv) and intravenous contrast
exposure.
7% Noise rejections.
|
| 3DMP EKG & mfEMT Analysis |
Myocardial Systems Expression |
80 to 90% |
90 to 95% |
95 to 100% |
80 to 90% |
5 minute test;
1-5 minute lag time4 |
Yes |
There is a positive correlation between the increasing
severity of CAD and the sensitivity of 3DMP/mfEMT in
detecting ischemia.
Additionally, an overal score for myocardial disease
severity is given to each individual to aid in immediate
diagnosis.
|
Information (except 3DMP/mfEMT data) from: Cleveland Clinic Intensive Cardiology Review Course, 2001.
3DMP/mfEMT Data from: Premier Heart Clinical Trials
1 - Percentage of lumenal encroachment by atherosclerotic plaque
2 - EST indicates Exercise Stress Testing
3 - Ann. Intern. Med. 2006; 145:407-415
4 - Dependent on internet connection speed
|
