Non-invasive diagnostic work-up Sample Clauses

Non-invasive diagnostic work-up. Stress ECG will be performed and its results (when evaluable) will be utilized to concur in identification of patients with intermediate pre-test probability to be enrolled. All included patients will undergo: a) CT angiography (CTA) to assess the presence of “anatomical” correlates of IHD, i.e. epicardial coronary lesions; b) stress imaging with stress radionuclide (SPECT or PET) and stress MRI or stress ECHO studies, to assess the presence of “functional” correlates of IHD, i.e. abnormal myocardial perfusion and contraction. All studies will be performed within two months from enrolment, according to standardized protocols; they will be registered on multimedial support (DVD) in standardized format and shipped for central readings. Records of measured radiation dose to the patient (when applicable) will be entered in the “patient record” into the Central Server. Patients who will not be able to perform one of the two non invasive stress tests will be kept into the study (with missing data). Patients who will refuse to perform invasive coronary angiography but will be submitted to CTA and functional stress tests (in particular in the case of normal non-invasive tests and/or CTA) will be kept into the study (with missing data). Patients who will refuse CTA but will perform functional stress tests and invasive coronary angiography will be kept into the study (with missing data). All patients will be encouraged to complete the whole protocol but, according to the above statements, a minimum of a functional stress test and an anatomic test will be considered sufficient to keep a patient into the study. Additional patients will be enrolled throughout the consortium to keep stable the final number of patients submitted to each combination of anatomo-functional non invasive modalities. Regarding the stress Echo and stress MRI studies, dobutamine will be used as a stressor in the majority of centers. High dose dipyridamole Echo or MRI will be performed in a minority of patients to allow the contemporary analysis of ventricular function and epicardial coronary flow reserve by Echo or myocardial perfusion by MRI. As far as the accuracy in the detection of ischemic wall motion abnormalities are concerned the 2 stressors are very similar (see References below) allowing to pool the data when accuracy of Echo-Stress or MRI-Stress will be compared with other stress imaging approaches. See references below.
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