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Answer 3
  1. Cardiac catheterization. Cardiac catheterization should be performed to rule out treatable and potentially reversible causes of decreased LV function. Patients with obstructive CAD and ischemic cardiomyopathies have a significant survival benefit with revascularization. Of patients with CAD evaluated for heart transplant, approximately 30% improve sufficiently and do not require transplant after revascularization. Delineation of the coronary anatomy is essential in patients with depressed LV function. Stress testing would not be appropriate because it fails to provide adequate information about the coronary anatomy; it might be helpful in evaluating functional status and risk for infarction or death in the coming year. Dobutamine echocardiography might be helpful in assessing for viable myocardium and helping to differentiate ischemic from idiopathic cardiomyopathy, but it is an indirect assessment. Magnetic resonance imaging and electron beam computed tomography are evolving tests for screening and diagnosis of CAD but would likely give abnormal results in a 60-year-old man.

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