Non-invasive assessment of the risk of coronary heart disease.

OBJECTIVE Non-invasive evaluations for the presence of coronary heart disease (CHD) are being done with increasing frequency in clinical medicine and as part of the risk selection process for life insurance. The predictive value of testing depends on the pretest probability of disease and the sensitivity and specificity of the testing used. This paper reviews the accuracy of exercise treadmill testing (ETT), myocardial perfusion imaging, stress echocardiography and electron beam computed tomography (EBCT) in the assessment of CHD risk. METHODS Literature review using Medline. RESULTS AND CONCLUSIONS Non-invasive testing is most useful in assessing persons with known or suspected coronary heart disease. Although a low pretest likelihood of disease limits the predictive value in young subjects and subjects with no known risk factors, a positive ETT or EBCT calcium score >160 may be viewed as a risk factor for CHD.

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