Should simultaneous exercise become the standard for adenosine myocardial perfusion imaging?

Concomitant low-level treadmill exercise with adenosine pharmacologic stress (AdenoEx) during radionuclide myocardial perfusion imaging has become commonly used in recent years, particularly in large-volume laboratories. A number of studies have demonstrated a beneficial impact of AdenoEx protocols. These benefits include decreased side effects, improved safety and patient tolerance, improved target-to-background ratios because of less subdiaphragmatic activity, and improved sensitivity and defect reversibility. In light of these benefits, recent reviews and guidelines call for the addition of low-level exercise to adenosine stress whenever possible.