New developments in pharmacological stress imaging

Abstract

Accurate assessment of the localization, extent and severity of jeopardized myocardium is invaluable for the management of patients with coronary artery disease. Moreover, identification of viable myocardium is of major importance when angioplasty or bypass-surgery is considered. Recent development of innovative imaging strategies provided the clinical cardiologist with new diagnostic tools to determine myocardial perfusion and left ventricular function. These imaging modalities require a (sub)maximal level of stress in order to increase coronary flow and myocardial oxygen demand. Although exercise is by far the most physiological method for producing a (sub)maximal level of stress, a considerable number of patients are unable to adequately perform conventional exercise stress testing. Pharmacological stress seems to be an appropriate substitute for bicycle and treadmill exercise, and is gaining increasing popularity. In addition, pharmacologically induced stress avoids excessive chest wall motion due to high respiration frequency, thereby contributing to high quality images. Currently, several stress agents are used in conjunction with thallium-201 scintigraphy, two-dimensional echocardiography and, recently, magnetic resonance imaging (MRI). The most employed agents include vasodilators such as dipyridamole and adenosine, and catecholamines such as dobutamine.KeywordsCoronary Artery DiseaseMyocardial Perfusion ImagingCoronary FlowCoronary Blood FlowPharmacological StressThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.