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Stress Modalities to Evaluate Myocardial Perfusion

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Nuclear Cardiology and Correlative Imaging

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Abstract

As discussed in Chapter 1, atherosclerotic lesions appear early in life.1,2 Considering its high incidence, which only increases with aging,3 the active search for coronary lesions, in the asymptomatic general population, does not seem reasonable. Lesions will often be found but will not necessarily be affecting myocardial perfusion in a significant way. Preservation of perfusion relates to other factors, including (1) the capacity of coronary vessels to dilate, known as coronary blood flow reserve (CBFR) and (2) the existence of a complex net of collateral vessels at the microcirculatory level. Whether coronary lesions will adversely affect myocardial blood flow (MBF) depends highly on the impact they have on CBFR and the existence or absence of good-quality collateral vessels. Evaluation of MBF, under stress, helps to determine the presence of coronary artery disease (CAD) affecting CBFR. The extent of myocardial ischemia and the degree of left ventricular dysfunction are key variables for determining prognosis that can be evaluated in nuclear cardiology using myocardial perfusion imaging (MPI). To test CBFR in nuclear cardiology, several stress modalities can be applied, including exercise, dipyridamole, adenosine, exercise combined with dipyridamole or adenosine, and dobutamine. Other less frequent forms of stress such as arbutamine, cardiac pacing, mental stress, and the cold pressor test, have also been used. These stress modalities are reviewed in this chapter.

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Authors
  1. João V. Vitola
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  2. Otávio J. Kormann
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  3. Arnaldo Laffitte Stier Jr.
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  4. William Azem Chalela
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  5. Luis E. Mastrocolla
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  6. Dominique Delbeke
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Editors and Affiliations

  1. Department of Medicine, Federal University of Paraná Medical School, 80050-010, Curitiba, Paraná, Brazil

    João V. Vitola MD, PhD (Associate Professor, Director) (Associate Professor, Director)

  2. Quanta Medicina Nuclear, 80050-010, Curitiba, Paraná, Brazil

    João V. Vitola MD, PhD (Associate Professor, Director) (Associate Professor, Director)

  3. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 37232, Nashville, TN, USA

    Dominique Delbeke MD, PhD (Professor and Director of Nuclear Medicine and PET) (Professor and Director of Nuclear Medicine and PET)

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Vitola, J.V., Kormann, O.J., Stier, A.L., Chalela, W.A., Mastrocolla, L.E., Delbeke, D. (2004). Stress Modalities to Evaluate Myocardial Perfusion. In: Vitola, J.V., Delbeke, D. (eds) Nuclear Cardiology and Correlative Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2038-1_4

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  • DOI: https://doi.org/10.1007/978-1-4612-2038-1_4

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