Diagnosis of Ischemic Heart Disease: Exercise ECG, Ergometry, and Coronary Angiography Techniques
Ischemic heart disease remains one of the leading causes of morbidity and mortality worldwide. The diagnosis of ischemic heart disease is crucial for the implementation of appropriate and timely therapeutic strategies. In this context, exercise ECG and coronary angiography are fundamental tools in the evaluation of patients suspected of having coronary artery disease.
Exercise Tests and Their Role in Diagnosis
Exercise tests, such as exercise ECG or ergometry, are non-invasive methods that allow for the assessment of the heart's response to physical exercise. These tests are particularly useful for risk stratification in patients with symptoms of stable angina. However, their applicability may be limited in certain patient groups, such as the elderly, due to comorbidities or an inability to perform adequate physical exercise [1].
In recent years, there has been a trend towards the use of more advanced imaging techniques, such as coronary computed tomography angiography (CCTA), which offers a detailed anatomical evaluation of the coronary arteries [2]. This technique has proven to be more accurate in identifying significant coronary stenosis and has positioned itself as a first-line tool in international guidelines for the evaluation of stable chest pain [3].
Coronary Angiography: The Gold Standard
Coronary catheterization or coronary angiography remains the gold standard for evaluating coronary anatomy. This invasive technique not only allows visualization of the coronary arteries but also enables therapeutic interventions if necessary. Although coronary angiography provides detailed information about the presence and severity of coronary disease, its use must be carefully considered due to the risks associated with invasive procedures [4].
Recent studies have shown that the combination of functional and anatomical tests can enhance diagnostic accuracy and better guide therapeutic decisions [5]. For example, integrating CCTA with exercise tests can provide a more comprehensive assessment of cardiovascular event risk in patients with ischemic heart disease [6].
Conclusions
The diagnosis of ischemic heart disease requires a multidimensional approach that combines both functional and anatomical tests. Exercise tests remain a valuable tool for initial evaluation and risk stratification, while coronary angiography provides definitive assessment of coronary anatomy. The choice of diagnostic modality should be individualized, taking into account patient characteristics and resource availability. The ongoing evolution of imaging techniques and the integration of new technologies, such as artificial intelligence, promise to further improve diagnostic accuracy and clinical outcomes in the future.
Referencias
[1] Noninvasive Testing for Diagnosis of Stable Coronary Artery Disease in the Elderly.
Created 2/1/2025