Various protocols exist for MPI, and each protocol has its advantages and disadvantages.1 ASNC Imaging Guidelines recommend that nuclear cardiology laboratories implement patient-centered imaging by choosing the proper imaging procedure for each individual patient.2
Exercise stress is preferred over pharmacologic stress testing when patients are able to exercise to 85% of the MPHR and ≥5 METs.1 For patients who experience symptoms such as moderate-to-severe chest pain, excessive shortness of breath, or fatigue during exercise stress prior to achieving adequate exercise, pharmacologic stress agents may be appropriate for MPI procedures.2
According to ASNC Imaging Guidelines, radiopharmaceuticals that limit radiation exposure and provide interpretable image quality are preferred. Also, 1-day protocols have advantages over 2-day procedures, except in large patients (>200 lb or body mass index [BMI] >30) and in patients who may have significant attenuation artifacts that might limit the interpretation of imaging results.1,2 When possible, stress/rest protocols may be preferable to rest/stress procedures to allow for stress-only imaging when the stress test is normal, as discussed in an ASNC Preferred Practice Statement.1
1. DePuey EG, Mahmarian JJ, Miller TD, et al. Patient-centered imaging. J Nucl Cardiol 2012;19(2):1-31. 2. Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures. J Nucl Cardiol 2016;23(3):606-39. Erratum in: J Nucl Cardiol 2016;23(3):640-2.