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Current Methods of Pharmacologic Stress Testing and the Potential Advantages of New Agents^*

Divisions of Cardiology and Nuclear Medicine, Departments of Medicine and Radiology, University of California San Francisco, San Francisco, California

Correspondence: For correspondence or reprints contact: Elias H. Botvinick, Box 0214, University of California San Francisco, 505 Parnassus Ave., Room M-308, San Francisco, CA 94143-0214. E-mail: botvinicke{at}medicine.ucsf.edu

ABSTRACT

This article presents the exciting advances made and ongoing in the area of pharmacologic cardiac stress testing. In particular, new A_2A-specific receptor agonists work like adenosine but promise the delivery of uncomplicated vasodilator stress testing or the diagnosis and prognosis of coronary disease. These agents, although not perfect, do likely present a level of protection against the complications of bronchospasm and heart block. Phase III studies have shown that these agents promise a reduced symptom intensity and greater patient tolerance. One of these agents, regadenoson, is now Food and Drug Administration approved and will be delivered as the same single-dose bolus in all patients, regardless of weight, greatly simplifying the method and increasing its acceptability. Most widely applied with myocardial perfusion SPECT, these agents will find application with PET myocardial perfusion studies and likely MRI studies. Because of their effect on coronary supply rather than demand, they will not be applied with stress echocardiography. Before considering these agents, we will consider the principles and methods of stress testing, and particularly pharmacologic stress testing. The learning objectives of this article are to familiarize the reader with the methods and choices in stress testing for coronary disease diagnosis and prognosis, to present the advantages and disadvantages of pharmacologic stress testing, to review current pharmacologic stress-testing methods and their specific combination with imaging methods, to present the chemistry and effects of the new A_2a-specific receptor agonists and their advantages compared with existing nonspecific agents, and to help the reader better understand the clinical role of the A_2a-specific receptor agonists and their application.

Key Words: cardiology (clinical); SPECT/CT; MRI; coronary artery disease; perfusion scintigraphy; pharmacologic stress; stress testing; vasodilator