Women and Myocardial Disease: ASNC Consensus Statement $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_10_01_nucmedarchive.php#85566971"; ?>
The American Society of Nuclear Cardiology has released a consensus statement on the role of myocardial perfusion imaging in the clinical evaluation of coronary artery disease in women. [article ]  posted at 10:59 PM by Tom Heston, MD   

Nuclear SPECT Scan More Cost-Effective Than Stress Echo $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_10_01_nucmedarchive.php#85562444"; ?>
This study concludes that when the pre-test likelihood of coronary artery disease is 30% or greater, the nuclear SPECT examination is more cost-effective than the stress echo exam, when used for the diagnosis of coronary artery disease. Among those with a lower pre-test likelihood, the nuclear SPECT scan is possibly, but not conclusively, the most cost-effective exam. It is possible that in some populations, the dobutamine echo is more cost-effective, but better outcomes data is needed before making this conclusion. In all scenarios examined, the exercise stress echo was not as cost-effective as the nuclear SPECT exam. Comment: several issues are important: a) when determining which test to utilize for the diagnosis of CAD, local availability and expertise is important since both the stress echo and nuclear SPECT exams require considerable technical expertise, b) the dobutamine stress echo test was more cost-effective than the exercise stress echo due to fewer inconclusive results, and c) overall, the most cost-effective test is not precisely known due to dispute over the value of a negative dobutamine stress echo (i.e. the hard cardiac event rate in patients with a negative test). If the hard event rate in those with a negative dobutamine echo test is 2%, then it is the most cost-effective approach. If the rate is 4%, then the nuclear SPECT scan is the most cost effective overall. In those with a pre-test probability of 30% for CAD, the nuclear SPECT scan was the most cost-effective approach. Thus, we may conclude that the nuclear SPECT exam is the most cost-effective approach in a large number of patients: #1- those with a pretest probability of disease of 30% or higher, and #2- in those with a pre-test likelihood of disease of less than 30%, the nuclear SPECT exam may also be the most cost-effective approach, depending upon the annual hard cardiac event rate in patients with a negative dobutamine echo. [ J Nucl Cardiol 2002;9:515-22 ]  posted at 9:34 PM by Tom Heston, MD   

EBCT: Use in Predicting Future Events and Diagnosing CAD $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_10_01_nucmedarchive.php#85517931"; ?>
This article on electron-beam CT discusses its use in predicting future events and diagnosing angiographically significant coronary artery stenosis. Comment: the biggest drawback of EBCT is the limited research behind its use. This article comes to the same conclusion. The nuclear perfusion and SPECT scan has much more extensive research to back up its predictive accuracy. [ Patient Care ]  posted at 6:05 PM by Tom Heston, MD   

Hormone Replacement Therapy Associated With False Positive Treadmill Stress Tests $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_10_01_nucmedarchive.php#85514280"; ?>
This study looked at 404 women undergoing SPECT myocardial perfusion imaging and found that 39% of the women on hormone replacement therapy had a false positive treadmill test. Both pre- and post-menopausal women had a false positive rate of approximately 20% on treadmill testing. [ J Nucl Cardiol July/August 2002 • Volume 9 • Number 4 ]  posted at 9:35 PM by Tom Heston, MD