Imaging Guidelines for Nuclear Cardiology Procedures

ASNC IMAGING GUIDELINES FOR NUCLEAR CARDIOLOGY PROCEDURES Stress protocols and tracers Milena J. Henzlova, MD, a Manuel D. Cerqueira, MD, b Christopher L. Hansen, MD, c Raymond Taillefer, MD, d and Siu-Sun Yao, MD e EXERCISE STRESS TEST Exercise is the preferred stress modality in patients who are able to exercise to an adequate workload (at least 85% of age-adjusted maximal predicted heart rate and five metabolic equivalents). Exercise Modalities 1. Treadmill exercise is the most widely used stress modality.

Several treadmill exercise protocols are described which differ in the speed and grade of treadmill inclination and may be more appropriate for specific patient populations. The Bruce and modified Bruce protocosls are the most widely used exercise protocols. 2. Upright bicycle exercise is commonly used in Europe. This is preferable if dynamic first-pass imaging is planned during exercise. Supine or semi- supine exercise is relatively suboptimal and should only be used while performing exercise radionuclide angiocardiography. Indications Indications for an exercise stress test are: 1. Detection of obstructive coronary artery disease (CAD) in the following: (a) Patients with an intermediate pretest probability of CAD based on age, gender, and symptoms. (b) Patients with high-risk factors for CAD (e.g., diabetes mellitus, peripheral, or cerebral vascular disease). 2. Risk stratification of post-myocardial infarction patients before discharge (submaximal test at 4-6 days), and early (symptom-limited at 14-21 days) or late (symptom-limited at 3-6 weeks) after discharge. 3. Risk stratification of patients with chronic stable CAD into a low-risk category that can be managed medically or into a high-risk category that should be considered for coronary revascularization. 4. Risk stratification of low-risk acute coronary syn- drome patients (without active ischemia and/or heart failure 6-12...

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