Routine Nuclear Stress Testing in Asymptomatic Atrial Fibrillation Has Low Yield

Wael A. Jaber, MD FACC, FAHA Professor of Medicine Cleveland Clinic Lerner College of Medicine Fuad Jubran Endowed Chair in Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland, OH

MedicalResearch.com Interview with:
Wael A. Jaber, MD FACC, FAHA
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Fuad Jubran Endowed Chair in Cardiovascular Medicine
Heart and Vascular Institute
Cleveland Clinic  Cleveland, OH

Medical Research: What is the background for this study? What are the main findings?

Prof. Jaber: Risk stratification of patients presenting with atrial fibrillation often includes a non-invasive evaluation for coronary artery disease. However, the yield of such testing in patients without angina or anginal-equivalent symptoms is uncertain. That is, how often do we find silent myocardial ischemia?

In our cohort of 1700 consecutive patients with atrial fibrillation, less than 5% had ischemia on nuclear stress testing, even though comorbidities were prevalent. Moreover, in patients with ischemia that had invasive coronary angiography, less than half had obstructive coronary artery disease.

Medical Research: What should clinicians and patients take away from your report?

Prof. Jaber: Routine nuclear stress testing in all patients with atrial fibrillation should be discouraged. In our study, the prevalence of ischemia as detected by nuclear stress testing did not increase with increasing cardiovascular risk (hypertension, hyperlipidemia, diabetes mellitus).  Instead, a more focused use of non-invasive imaging based upon a patient’s symptoms should be adopted.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Jaber: Future research could include studying the comparative effectiveness and yield of various imaging modalities (stress echocardiography, nuclear, CTA, MRI) in a population presenting with atrial fibrillation. In addition, the assumed value of stress imaging in “clearing” patients for Class IC anti-arrhythmics should be prospectively evaluated.

Citation:

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JABERW@ccf.org

Wael A. Jaber, MD FACC, FAHA (2015). Routine Nuclear Stress Testing in Asymptomatic Atrial Fibrillation Has Low Yield MedicalResearch.com

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