Both Exercise and Adenosine Stress Testing

Coronary artery disease remains the leading cause of morbidity and mortality in women
accounting for more than 250,000 deaths per year. Despite the high prevalence in ischemic
heart disease in women, most clinical trials have focused on male cohorts. The optimal
non-invasive test for evaluation of ischemic heart disease in women is unknown. A number of
different modalities have been employed including exercise ECG stress testing, 2-dimensional
stress echocardiography, SPECT myocardial perfusion imaging, and electron beam computerized
tomography.

The cohort of women for whom to perform testing upon is also ill-defined. Myocardial
perfusion imaging, in conjunction with pharmacologic stress testing, has also been shown to
be effective in the diagnosis of women with known or suspected coronary artery disease as
well as in for risk stratification. Recently, pharmacologic stress has been combined with
low-level exercise, enhancing test tolerability and SPECT perfusion image quality.
Furthermore, the use of a combined adenosine and exercise protocol may detect greater
amounts of ischemia with perfusion imaging that with an exercise test alone. Therefore, in
women who may be unable to perform maximal exercise, this combined pharmacologic and
exercise imaging protocol may possess a significant advantage over adenosine stress testing
alone.

The aim of this study is to compare safety and symptoms associated with these two methods of
stress testing. The current study also seeks to establish the optimal method for detection
of coronary artery disease in women who have a limited capacity for exercise (DASI score ≤5
METS), also well as examine the prognostic value of each method of testing by comparing the
two-year event rates for women who undergo adenosine SPECT imaging or SPECT imaging using
adenosine with adjunctive exercise.