Alternative stress methods for the diagnosis of coronary artery disease

Bicycle exercise and treadmill exercise are the commonest devices used in the evaluation of coronary artery disease. However, not all patients are capable of performing a maximal exercise test due to orthopaedic, vascular or pulmonary disease, poor physical condition and motivation. Alternative tests as a reliable substitute for the more conventional methods have been proposed, such as right atrial pacing, arm ergometry, handgrip test, cold pressure test, and inotropic stimulation. In particular, pharmacological stress testing with dipyridamole (and recently with adenosine and dobutamine) in combination with radionuclide techniques has gained much interest. This review will consider the usefulness and role of alternative stress testing to provoke myocardial ischaemia, with emphasis on pharmacological stress testing in conjunction with thallium-201 myocardial perfusion scintigraphy.