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| Screening methods | Detection of prevalent CHD | Comments |
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| Functional tests |
| Resting electrocardiogram (ECG) | Low sensitivity and specificity | Widely available, very low cost |
| Exercise ECG | Moderate sensitivity (45–61%) and specificity (70–90%) | Relatively low cost, widely available
Many patients unable to exercise
Some have uninterpretable baseline ECGs |
| Radionuclide single proton emission computed tomography (SPECT) myocardial perfusion imaging (MPI) | Good sensitivity (80–90%) and specificity (75–90%)
The most widely used test to assess silent myocardial ischaemia | Moderate to high cost
Widely available
High negative predictive value (95%)
Image quality affected by body habitus and large breasts
Screening of asymptomatic patients not prognostically useful unless high-risk patients are selected |
| Myocardial perfusion imaging (MPI) with positron emission tomography (PET) | High sensitivity for myocardial viability studies
Accurate global and regional measurements of myocardial perfusion, blood flow, and function at stress and rest in a single study | Better image quality because of higher spatial resolution, less scattered, and fewer attenuation artifacts
Lower radiation exposure than SPECT
Costly, not universally available |
Stress echocardiography
(i) Exercise stress echo
(ii) Pharmacologic stress echo (dobutamine, adenosine, and dipyridamole) | The sensitivity and specificity are satisfactory (80–85%)
Able to assess LV function and valvular abnormalities | Low cost, widely available
Operator dependent
Difficulty in interpreting the images in obese persons |
|
| Anatomic (imaging) techniques |
| Coronary artery calcium score (CAC) | CAC more prevalent in people with diabetes than nondiabetes
Closely associated with total coronary artery atherosclerotic plaque burden
Predicts incident ischaemia, CHD morbidity and mortality | Moderate to high cost
No differentiation between obstructive and nonobstructive CHD
Up to 25% of patients have minimal or no CAC at the time of screening |
| Multidetector-row computed tomography (MRCT) angiography | High sensitivity (83–99%) and specificity (93–98%) | Good sensitivity, specificity, and negative predictive value. High radiation doses
High cost |
| Magnetic resonance imaging (MRI) | Good sensitivity (83–90%) and specificity (72–84%)
Delayed gadolinium hyperenhancement linked to increased risk of major cardiovascular events
Not adequately investigated | Able to assess myocardial structure and function and characterize ischemic, inflammatory and various types of cardiomyopathies
High cost |
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