Journal of Nuclear Cardiology

, Volume 24, Issue 2, pp 546–554 | Cite as

Comparison of the current reasons for undergoing pharmacologic stress during echocardiographic and radionuclide stress testing

  • Edgar ArgulianEmail author
  • Jose Ricardo F. Po
  • Seth Uretsky
  • Kiran K. Kommaraju
  • Suketukumar Patel
  • Vikram Agarwal
  • Randy Cohen
  • Alan Rozanski
Original Article



Symptom-limited exercise is the preferred method of cardiac stress testing, but pharmacologic testing has been increasing over time. The exact reasons for pharmacologic stress testing have not been rigorously categorized. Thus, we systematically explored the reasons for pharmacologic stress testing in patients referred for cardiac stress imaging.


We studied consecutive patients referred for stress imaging [stress echocardiography or radionuclide myocardial perfusion imaging (MPI)] at Mount Sinai St Luke’s hospital between August 2013 and April 2014. Baseline information was obtained using a standardized questionnaire and a trained physician triaged the patient for symptom-limited exercise stress testing or pharmacologic stress testing.


In total, 551(48%) of our entire stress cohort underwent cardiac imaging following initial exercise testing and 589 (52%) underwent imaging with initial pharmacologic stress testing. Deconditioning and inability to walk (primarily due to musculoskeletal conditions) constituted the top two reasons for performing pharmacologic stress, followed by frailty, left bundle branch block (for MPI), resting wall motion abnormality (for echocardiography), and failed exercise attempts. The reasons for performing pharmacologic stress testing were similar in the MPI and echocardiography patients, despite a much higher level of disease acuity in the MPI group.


We have applied a systematic approach for categorizing the reasons for pharmacologic stress. These reasons are heterogeneous, but similar across MPI and echo stress laboratories.


Stress testing echocardiography myocardial perfusion imaging 



Myocardial perfusion imaging


Single-photon emission computed tomography



The authors transfer all copyright ownership of the manuscript to the American Society of Nuclear Cardiology in the event the work is published. The authors warrant that the article is original, does not infringe upon any copyright or other proprietary right of any third party, is not under consideration by another journal, and has not been previously published. The final manuscript has been read, and each author’s contribution has been approved by the appropriate author. The authors attest that they will not distribute copies or reprints of this article for commercial use prior to its publication in the Journal. The authors further attest that there are no financial or other relationships relevant to this manuscript.


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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Edgar Argulian
    • 1
    • 2
    Email author
  • Jose Ricardo F. Po
    • 3
  • Seth Uretsky
    • 1
    • 2
    • 4
  • Kiran K. Kommaraju
    • 1
    • 2
  • Suketukumar Patel
    • 1
    • 2
  • Vikram Agarwal
    • 1
    • 2
  • Randy Cohen
    • 1
    • 2
  • Alan Rozanski
    • 1
    • 2
  1. 1.Division of CardiologyMount Sinai St. Luke’s HospitalNew YorkUSA
  2. 2.The Icahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Allegheny General HospitalPittsburghUSA
  4. 4.Morristown Medical CenterMorristownUSA

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