For a rational use of stress tests and an appropriate interpretation of their results, it may be useful to adopt a pathogenetic classification, taking into account the diagnostic endpoint of the test. Tests inducing vasospasm (ergonovine infusion and hyperventilation) explore the functional component. Tests trying to unmask coronary stenosis (exercise, dipyridamole, adenosine, dobutamine, pacing) mostly explore the ceiling of coronary reserve as defined by organic factors. Each of the prototype stresses for the detection of coronary artery disease can induce ischemia through either one of the two main pathophysiological pathways: “steal effect” (dominant mechanism with dipyridamole or adenosine) and increased oxygen demand (dominant with exercise or dobutamine). Both families of stresses are more or less equally effective as ischemic stressors in the presence of significant coronary artery disease. The relevance of the steal effect is also directly mirrored by the stress capacity to recruit coronary flow reserve. Adenosinergic stresses are ideally suited for this, since – unlike dobutamine or exercise associated with a threefold flow increase – they determine a fivefold increase in coronary blood flow with a full recruitment of pharmacological flow reserve. The greater the vasodilation, the higher the potential for inappropriate steal phenomena in the presence of coronary artery disease. In recent years, the different sides of the coin of the stress test, vasodilatory and ischemic stress, merged in the dual imaging of coronary flow reserve and wall motion during vasodilatory stress echocardiography.
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Keywords
- Leave Anterior Descend
- Right Coronary Artery
- Coronary Flow Reserve
- Coronary Stenosis
- Coronary Artery Stenosis
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Picano, E. (2009). Pathogenetic Mechanisms of Stress. In: Picano, E. (eds) Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-76466-3_5
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