Coronary artery disease detection - limitations of stress testing in left ventricular dysfunction

Core Tip

Core tip: Left ventricular systolic dysfunction is common in clinical practice and may be detected in asymptomatic patients. The timely and definitive exclusion of an ischemic etiology is central to optimizing care and reducing mortality. Clinician experience, imaging modality characteristics, cost and safety determine the choice of testing. We compare the diagnostic utility of established tests like nuclear and echocardiographic stress testing with newer techniques like coronary computerized tomography and cardiac magnetic resonance imaging. Due to limitations inherent to each non-invasive modality, oftentimes cardiac catheterization remains the definitive method to exclude coronary artery disease in patients with underlying left ventricular dysfunction.