Myocardial Perfusion Imaging (MPI) Stress Test

Introduction

A myocardial perfusion imaging (MPI) stress test is a non-invasive diagnostic procedure used to evaluate blood flow to the heart muscle (myocardium). It helps detect coronary artery disease (CAD), assess areas of reduced blood supply, and evaluate heart function both at rest and under stress.

Why is it Done?

Doctors recommend an MPI stress test to: - Diagnose coronary artery disease (CAD) - Evaluate chest pain and unexplained shortness of breath - Assess severity of known heart disease - Monitor the effects of treatment or interventions (such as stents or bypass surgery) - Determine a patient’s risk of future heart attacks

How Does the Test Work?

The test involves two parts: 1. Resting Phase : A small amount of a radioactive tracer (such as technetium-99m or thallium-201) is injected into a vein. Special cameras take images of blood flow to the heart at rest. 2. Stress Phase : Stress is induced either with physical exercise (treadmill/bicycle) or medication (such as adenosine or regadenoson), which mimics the effects of exercise. Another dose of the tracer is injected, and new images are taken to compare blood flow during stress vs. rest.

How to Prepare for the Test

  • Avoid caffeine, nicotine, and certain medications that can interfere with the results
  • Follow fasting instructions (usually no food or drink for a few hours before the test)
  • Wear comfortable clothes and walking shoes if you’re undergoing exercise stress testing

Understanding the Results

  • Normal MPI scan : Shows uniform blood flow to all areas of the heart, both at rest and under stress.
  • Abnormal MPI scan : Indicates areas of the heart receiving reduced blood flow, suggesting blocked or narrowed coronary arteries, or prior damage from a heart attack.

Risks and Considerations

  • The test is generally safe, but the radioactive tracer involves minimal exposure to radiation.
  • Some people may experience mild side effects, such as dizziness, headache, or flushing with stress medications.
  • Allergic reactions to the tracer are rare but possible.

Conclusion

An MPI stress test is a valuable tool in detecting and assessing coronary artery disease. It provides critical information about your heart’s health and helps guide treatment decisions to reduce the risk of heart complications.

Source recommendations

1. American Heart Association Guidelines on Nuclear Cardiology

  1. https://www.asnc.org/
  2. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/myocardial-perfusion-imaging-mpi-test
  3. https://pubmed.ncbi.nlm.nih.gov/22075469/
  4. https://www.ahajournals.org/doi/10.1161/01.cir.0000080946.42225.4d
  5. https://pubmed.ncbi.nlm.nih.gov/14522503/

2. European Society of Cardiology Guidelines on Cardiovascular Imaging

  1. https://www.escardio.org/Sub-specialty-communities/European-Association-of-Cardiovascular-Imaging-(EACVI)
  2. https://academic.oup.com/ehjcimaging
  3. https://www.escardio.org/Guidelines/Scientific-Documents/Recommendations-and-position-papers
  4. https://academic.oup.com/ehjcimaging/article/16/9/919/2399830
  5. https://www.escardio.org/Guidelines/Recommended-Reading/Cardiovascular-Imaging

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