From the Guidelines
A stress study for cardiac evaluation is typically an exercise-based stress test or a pharmacologically induced stress test, which aims to evaluate the extent and adequacy of the hyperemic response and assess the ability of the coronary circulation to augment flow to meet increasing work demand. To evaluate cardiac function, a stress test can be used to determine the adequacy of cardiac function, as exercise can elicit cardiovascular abnormalities that are not present at rest 1. The objective of stress testing is to assess the ability of the coronary circulation to augment flow to meet increasing work demand, thereby evaluating the extent and adequacy of the hyperemic response 1. When used in combination with imaging, stress testing can elicit and evaluate the ischemic endpoints that relate to coronary supply or demand imbalance characteristic of CAD, including perfusion, myocardial stiffening, wall motion abnormalities, electrocardiographic stress test segment changes, and chest pain 1. Some key points to consider when performing a stress study for cardiac evaluation include:
- Exercise-based stress testing is preferred to pharmacologically induced stress testing when possible 1
- Pharmacologic stress perfusion endpoint can be used with various forms of MPI, and the functional ischemic endpoint can be detected and monitored during dynamic myocardial contraction imaging 1
- The choice of stress test depends on the patient's ability to exercise and the specific clinical question being addressed 1. It is essential to note that the term "stress test" is often used interchangeably with "exercise test," but it is more appropriate to call an exercise test exactly that, rather than a "stress test," considering the increased use of nonexercise stress tests 1.
From the Research
Definition and Purpose of Stress Study for Cardiac Evaluation
- A stress study for cardiac evaluation is a diagnostic test used to assess the heart's function under physical or mental stress 2.
- The purpose of a stress study is to evaluate the heart's response to stress, which can help identify potential cardiac problems, such as coronary artery disease or heart failure 2.
Methods of Stress Induction
- There are several methods to induce stress in humans, including:
- Cold pressor test
- Trier Social Stress Test
- Montreal Imaging Stress Task
- Maastricht Acute Stress Test
- CO2 challenge test
- Stroop test
- Paced Auditory Serial Addition Task
- Noise stress
- Mannheim Multicomponent Stress Test 2
- These methods can be used to assess the physiological and behavioral changes that occur in response to stress 2.
Assessment of Stress Response
- Stress assessment in humans can be done by measuring biochemical markers, such as cortisol, cortisol awakening response, and dexamethasone suppression test 2.
- Physiological and behavioral changes, such as galvanic skin response, heart rate variability, pupil size, and muscle and/or skin sympathetic nerve activity, can also be monitored to assess stress response 2.
- Cardiovascular parameters, such as heart rate, blood pressure, and self-reported anxiety, can also be used to evaluate the stress response 2.
Importance of Stress Study for Cardiac Evaluation
- Stress studies can help identify individual stress patterns, which can be used to develop and recommend treatment strategies 3.
- Assessing stress exposure and responses can help prevent or treat chronic mental and physical health problems, including heart disease 4.
- Stress measurement can be useful in primary care settings to improve outcomes and reduce chronic disease burden 4.