title: Comparison of the current reasons for undergoing pharmacologic stress during echocardiographic and radionuclide stress testing.
abstract: 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.
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, 1111 Amersterdam Avenue, New York, NY, USA. earguli@alum.emory.edu.|The Icahn School of Medicine at Mount Sinai, New York, NY, USA. earguli@alum.emory.edu.
authors.forename: Edgar
authors.initials: E
authors.lastname: Argulian
authors.affiliation: Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Jose Ricardo F
authors.initials: JRF
authors.lastname: Po
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, 1111 Amersterdam Avenue, New York, NY, USA.|The Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Morristown Medical Center, Morristown, NJ, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Uretsky
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, 1111 Amersterdam Avenue, New York, NY, USA.|The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Kommaraju
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, 1111 Amersterdam Avenue, New York, NY, USA.|The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Suketukumar
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, 1111 Amersterdam Avenue, New York, NY, USA.|The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Vikram
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, 1111 Amersterdam Avenue, New York, NY, USA.|The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Randy
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, 1111 Amersterdam Avenue, New York, NY, USA.|The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
mesh_terms: D000368:Aged; D000465:Algorithms; D000066491:Clinical Decision-Making; D025401:Echocardiography, Stress / Q000379:methods / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000706:statistics & numerical data*; D009518:New York / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging / Q000379:methods* / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014600:Utilization Review; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents
keywords: Stress testing; echocardiography; myocardial perfusion imaging