Indications for Nuclear Imaging for Risk Stratification

Indications for Nuclear Myocardial Perfusion Imaging (MPI):

 

Exercise MPI:

  • Intermediate-high risk, able to exercise, with uninterpretable ECG (class I) or interpretable ECG (class IIa) 
  • Known SIHD, able to exercise, new symptoms
  • Contraindications to Exercise MPI:
    • Low-risk & able to exercise –> instead do Exercise ECG
    • Routine LV function if no new signs/symptoms
    • No changes < 5 yr after ACB surgery or < 2 yr after PCI
    • Essentially asymptomatic patients

 

Pharmacological MPI:

  • Intermediate-high risk and unable to exercise
  • Left Bundle Branch Block (LBBB) regardless of exercise
  • Known SIHD, unable to exercise or LBBB, new symptoms
  • Contraindications to Pharma MPI:  
    • Low-risk & able to exercise  –> instead do an Exercise ECG
    • Intermediate-high risk, able to exercise, interpretable ECG  –> instead do exercise ECG or MPI
    • Routine LV function if no new signs/symptoms
    • No changes < 5 yr after ACB surgery or < 2 yr after PCI
    • Essentially asymptomatic patients

 

Uninterpretable ECG, remember the mnemonic PELViS:

  • P:  pre-excitation (WPW)
  • E:  excess of > 1 mm ST depression
  • L:  left bundle branch block (LBBB)
  • V:  ventricular pacing
  • i
  • S:  ST/T changes from LVH or digoxin for example

 

 

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