Practice Guidelines

ECG, Echocardiography, or MPI for Cardiac Screening: Guidance from the ACP


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Am Fam Physician. 2015 Sep 15;92(6):531.

Key Points for Practice

• Cardiac disease screening using resting or stress ECG, stress echocardiography, or stress MPI should not be performed in low-risk adults without symptoms.

• Emphasis of care should be on reducing the factors that affect a patient's cardiovascular risk and promoting exercise.

From the AFP Editors

In the United States, one in three deaths is from cardiovascular disease; coronary heart disease is the leading cause of death. Screening for coronary heart disease can be performed with resting or stress electrocardiography (ECG), stress echocardiography, or myocardial perfusion imaging (MPI). This guideline from the American College of Physicians (ACP) provides recommendations on cardiac screening using these modalities.

Recommendations and Practice

Although the benefit of cardiac screening in adults at low-risk of coronary heart disease is questionable, it is often still performed. The American Heart Association, among other organizations, does not recommend performing ECG for cardiac screening in low-risk adults, and the U.S. Preventive Services Task Force specifically recommends against it. With regard to stress echocardiography and MPI,

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at


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