For many decades, stress testing has been at the core of the diagnostic evaluation algorithm for detection of obstructive coronary artery disease (CAD) for the patient presenting with stable, suspected ischemic heart disease.1 The underlying rationale for stress testing is based on the principle of demand ischemia, whereby above a patient-specific exercise workload, myocardial ischemia may be induced in the setting of a functionally limited stenosis. Since the early days of the Master step test, graded exercise with observation of an ischemic threshold has been undertaken to corroborate the patient’s presenting suspected cardiac symptoms and, if positive, to guide anti-ischemic therapy and invasive coronary angiography (ICA) use.
Shaw LJ, Nicol E. Lesion-Specific Ischemia With Noninvasive Computed Tomographic AngiographySuperior to Conventional Stress Testing?. JAMA Cardiol. Published online May 24, 2017. doi:10.1001/jamacardio.2017.1315