[An aggressive exercise test is suitable for myocardial scintigraphy].

Exercise myocardial scintigraphy is frequently used as a second step tool in the assessment of coronary artery disease. Little attention has been paid on the exercise protocol used as a stress during scintigraphy. However, the diagnostic accuracy of the test is better if higher heart rate is achieved. The aim of this study was to evaluate if an aggressive exercise protocol was safe and more effective than a standard protocol in achieving higher heart rate. Eighty-four patients (64 men and 20 women, mean age 56 +/- 10 years, range 34-78 years) underwent a standard exercise test (cycloergometry; SET: 25 W increments every 2 min starting from 25 W load) and an aggressive exercise test (AET: 50 W increments every 2 min starting from 50 W load); during AET a myocardial scintigraphy (Tc-99m sestamibi; SPECT) was performed. Heart rate and blood pressure were monitored during the tests and the rate-pressure product was calculated. No patients had major adverse events during either tests. During AET with respect to the SET, higher maximal heart rate (142 +/- 15 vs 134 +/- 16 b/min; p < 0.01) and rate-pressure product (27,293 +/- 4341 vs 25,773 +/- 6690 b/min x mmHg; p < 0.05) were obtained. During AET higher number of maximal (55/84 vs 34/84; p < 0.05) and positive tests (45/84 vs 29/84; p < 0.05) were detected with respect to the SET. Using myocardial scintigraphy as a reference test, the diagnostic accuracy of the SET and AET was 54 and 73% respectively. In conclusion, an aggressive protocol during exercise stress test can safely be used to obtain a greater number of maximal and positive exercise tests.