Pharmacologic stress myocardial perfusion imaging : A practical approach

In the substantial proportion of patients in whom exercise stress testing is not possible, pharmacologic stress MPI is an important tool in the detection of ischemic heart disease. With careful attention to patient selection, performance of the pharmacologic stress protocols, addition of adjunctive low-level exercise stress whenever possible, and measures to optimize image quality, important diagnostic and prognostic information can be obtained, comparable to that produced with standard exercise stress testing. Novel vasodilator stress agents, currently under development, such as the selective adenosine A2A receptor agonists regadenoson and binodenoson, may allow for reduced pulmonary and bradycardiac side effects, enhanced ease of administration, and possibly, greater inclusion of patients with pulmonary disease.33,34 As older patients with multiple comorbidities are increasingly referred for nuclear cardiology studies, the ability to perform high-quality pharmacologic stress MPI is a basic requirement of the contemporary nuclear cardiology laboratory.