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Stress echocardiography and MPS are clinically useful tools for selection of patients with known or suspected CAD who are likely to benefit from revascularization. Both imaging modalities are the mainstay tests for the diagnosis of in-stent stenosis and graft disease and are integral parts of the investigative strategies recommended by both European and American guidelines. However, CMR and multislice computed tomography are increasingly used for this purpose in centers with access to these techniques. Myocardial perfusion and wall motion abnormalities after myocardial revascularization are predictive of cardiac events and the risk associated with these abnormalities is not related to symptoms.

The assessment and triage of ED patients with suspected ACS is a process that requires considerations of clinical risk, patient safety, and cost-effectiveness. The strategies used should be highly sensitive to minimize the chances of missing the diagnosis of ACS. The noninvasive modalities of MPI and echocardiography have suitable characteristics. Data on MPI predominate in the literature, with prospective, randomized studies demonstrating applicability, safety, and cost-effectiveness, such that ED MPI for evaluation of suspected ACS has attained a class I, level A indication in the US. In the future, imaging of ischemic memory using fatty acid analogs such as BMIPP may further enhance the utility of radionuclide imaging in this setting.

The pathophysiology of myocardial ischemia involves a series of progressive changes from the cellular level through perfusion abnormalities, contractile dysfunction, electrocardiographic abnormalities, and finally symptoms. In clinical practice, it has multiple potential manifestations, with atherosclerotic coronary disease being the most important underlying etiology. Uncovering these abnormalities or their underlying causes requires selection of the most appropriate stress method depending on the question being asked, and the clinical status of the patient. A sound understanding of the principles of imaging will contribute to informed interpretation of test results. Only by integrating knowledge of the pathophysiology of myocardial ischemia, the role of the various stress modalities, and the strengths and weaknesses of the available imaging technologies will the best possible test be selected for each patient.

Stress echocardiography and MPS are clinically useful tools for selection of patients with known or suspected CAD who are likely to benefit from revascularization. Both imaging modalities are the mainstay tests for the diagnosis of in-stent stenosis and graft disease and are integral parts of the investigative strategies recommended by both European and American guidelines. However, CMR and multislice computed tomography are increasingly used for this purpose in centers with access to these techniques. Myocardial perfusion and wall motion abnormalities after myocardial revascularization are predictive of cardiac events and the risk associated with these abnormalities is not related to symptoms.

Stress echocardiography and MPS are clinically useful tools for selection of patients with known or suspected CAD who are likely to benefit from revascularization. Both imaging modalities are the mainstay tests for the diagnosis of in-stent stenosis and graft disease and are integral parts of the investigative strategies recommended by both European and American guidelines. However, CMR and multislice computed tomography are increasingly used for this purpose in centers with access to these techniques. Myocardial perfusion and wall motion abnormalities after myocardial revascularization are predictive of cardiac events and the risk associated with these abnormalities is not related to symptoms.

Echocardiography is an important tool for patients with CAD. It can be used to differentiate regional myocardial ischemia from other etiologies of chest pain, can be used to evaluate the extent of myocardial dysfunction, at rest and with stress, and to ascertain the presence of complications in patients with acute myocardial infarction. With the prospect of identifying myocardial perfusion defects, echocardiography is clearly an approach that can provide a “one-stop” strategy for assessing cardiac anatomy, function, and perfusion.

Consider a linear time-invariant system with the following dynamics: where () ∈ ℝ is the state vector at time , ∈ ℝ is the initial state, and is a constant known matrix with appropriate dimension. The stability of this class of systems has been extensively studied and many interesting results can be used to check the stability of a given system of this class. Lyapunov equations or equivalent LMI conditions are often used to check stability.