The most sensitive and practical technique for detection of myocardial ischemia in the perioperative period is –
Two dimensional transesophageal echocardiography is the most sensitive method to detect myocardial ischemia in the perioperative period.
But there are doubts, if its a practical procedure too.
Morgan states
"Detection of regional wall motion abnormality is a rapid and more sensitive indicator of myocardial ischemia than is the E.C.G but unfortunately TEE requires expensive equipment and considerable familiarity with the technique in order to make correct and rapid interpretations intraoperatively".
Magnetic Resonance Spectroscopy
Radio labeled lactate determination
Direct measurement of end diastolic pressure
Regional wall motion abnormality detected with the help of 2D transoesophageal echocardiography