Pharmacological agents for stress testing in the diagnosis of coronary artery disease

Non-invasive diagnosis of coronary artery disease is based on the combined use of a technique capable of identifying accurately the presence of ischaemia and a stress capable of safely inducing myocardial ischaemia. In the last few years great progress has been made in this field thanks to the use (a) of cardiac imaging techniques that clearly depict the presence and extent of myocardial ischaemia and to (b) the introduction of stresses other than exercise. These stresses are mainly pharmacological and are particularly useful in patients unable to exercise or who cannot exercise to a level considered adequate for diagnostic purposes. These alternative stress procedures are particularly useful when dealing with echocardiography since exercise usually prevents the acquisition of images of sufficient quality to be considered diagnostic.