Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Impact of medications and methylxanthines on stress testing

Gary V Heller, MD, PhD, FACC, MASNC
Section Editor
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editor
Brian C Downey, MD, FACC


Medications and patient diet may alter hemodynamics, electrolyte levels, or endothelial function, and potentially limit the accuracy of any stress testing modality for determining the presence of significant coronary heart disease (CHD). Certain medications may lead to "false negative" results while others may yield "false positive" results. Thus the decision to discontinue medications or dietary components is an integral part of ordering these tests, with the decision to withdraw medication based on the clinical circumstances, the indications for stress testing, and the type of stress testing performed.

The interaction between major cardiovascular medications and stress testing will be discussed here. Indications and procedures for stress testing are discussed separately. (See "Selecting the optimal cardiac stress test" and "Stress testing for the diagnosis of obstructive coronary heart disease" and "Exercise ECG testing: Performing the test and interpreting the ECG results" and "Overview of stress radionuclide myocardial perfusion imaging" and "Overview of stress echocardiography" and "Stress testing to determine prognosis of coronary heart disease".)


A false negative stress test result occurs when a stress test fails to detect clinically significant coronary heart disease (CHD). In contrast, a false positive stress test result suggests underlying clinically significant CHD when no such disease exists. Medications and patient diet may result in false negative or false positive stress test results. Patients with false negative results may not receive appropriate medical therapy, potentially leading to worse clinical outcomes. In contrast, patients with false positive results may be subjected to further noninvasive or invasive testing with possible adverse outcomes. False positive results may also lead to treatment with unnecessary medical therapy and its associated risks and costs. Therefore, understanding the mechanisms by which medications and dietary ingestions can alter stress test results is critical to optimizing the information obtained from stress testing.

Stress testing is performed using exercise or medications to increase coronary artery blood flow and/or myocardial oxygen requirements. Coronary blood flow increases to various degrees depending on the type of stress testing and the degree of stenosis. Exercise induces vasodilation and a two- to threefold increase in blood flow in normal coronary arteries [1]. Exercise also induces paradoxical vasoconstriction in stenotic segments, (secondary to endothelial dysfunction), which results in a myocardial oxygen demand/supply mismatch in stenotic segments and heterogeneity in the perfusion of normal and stenotic segments [2-10]. Vasodilators used in stress testing increase flow in normal coronary arteries three- to fivefold, while arteries with a significant stenosis are not able to increase flow to the same extent, thus creating a heterogeneity in flow and tracer uptake [11,12].

A stress test is interpreted as positive or negative based upon patterns seen on the electrocardiogram (ECG) and, when performed, an accompanying imaging study (eg, myocardial perfusion imaging, echocardiographic imaging). False results can be seen on either of these studies. Medications and dietary ingestions can yield false negative results on the ECG, the imaging study, or both, and false positive results on the ECG. While false positive imaging results may occur (ie, due to soft tissue attenuation or adjacent bowel activity), medications and dietary ingestions have not been shown to yield false positive results on the imaging portion of a stress test.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 25, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Udelson JE, Dilsizian V, Bonow RO. Nuclear Cardiology. In: Braunwald's Heart Disease, 7th ed, Zipes DP, Libby P, Bonow RO, Braunwald E (Eds), Elsevier Saunders, Philadelphia 2005. p.287.
  2. Gielen S, Schuler G, Hambrecht R. Exercise training in coronary artery disease and coronary vasomotion. Circulation 2001; 103:E1.
  3. Sambuceti G, Marzilli M, Marraccini P, et al. Coronary vasoconstriction during myocardial ischemia induced by rises in metabolic demand in patients with coronary artery disease. Circulation 1997; 95:2652.
  4. Bogaty P, Hackett D, Davies G, Maseri A. Vasoreactivity of the culprit lesion in unstable angina. Circulation 1994; 90:5.
  5. Frielingsdorf J, Seiler C, Kaufmann P, et al. Normalization of abnormal coronary vasomotion by calcium antagonists in patients with hypertension. Circulation 1996; 93:1380.
  6. Chierchia S, Muiesan L, Davies A, et al. Role of the sympathetic nervous system in the pathogenesis of chronic stable angina. Implications for the mechanism of action of beta-blockers. Circulation 1990; 82:II71.
  7. Bortone AS, Hess OM, Gaglione A, et al. Effect of intravenous propranolol on coronary vasomotion at rest and during dynamic exercise in patients with coronary artery disease. Circulation 1990; 81:1225.
  8. Nabel EG, Selwyn AP, Ganz P. Paradoxical narrowing of atherosclerotic coronary arteries induced by increases in heart rate. Circulation 1990; 81:850.
  9. Bache RJ. Effects of calcium entry blockade on myocardial blood flow. Circulation 1989; 80:IV40.
  10. Bortone AS, Hess OM, Eberli FR, et al. Abnormal coronary vasomotion during exercise in patients with normal coronary arteries and reduced coronary flow reserve. Circulation 1989; 79:516.
  11. Zoghbi GJ, Iskandrian AE. Coronary Artery Disease Detection: Pharmacologic Stress. In: Clinical Nuclear Cardiology State of the Art and Future Directions, 3rd ed, Zaret BL, Beller GA (Eds), Elsevier Mosby, 2005. p.233.
  12. Gould KL. Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilatation. I. Physiologic basis and experimental validation. Am J Cardiol 1978; 41:267.
  13. Hauser AM, Gangadharan V, Ramos RG, et al. Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. J Am Coll Cardiol 1985; 5:193.
  14. Nesto RW, Kowalchuk GJ. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 1987; 59:23C.
  15. Diaz LA, Brunken RC, Blackstone EH, et al. Independent contribution of myocardial perfusion defects to exercise capacity and heart rate recovery for prediction of all-cause mortality in patients with known or suspected coronary heart disease. J Am Coll Cardiol 2001; 37:1558.
  16. Iskandrian AS, Chae SC, Heo J, et al. Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol 1993; 22:665.
  17. Snader CE, Marwick TH, Pashkow FJ, et al. Importance of estimated functional capacity as a predictor of all-cause mortality among patients referred for exercise thallium single-photon emission computed tomography: report of 3,400 patients from a single center. J Am Coll Cardiol 1997; 30:641.
  18. Travin MI, Boucher CA, Newell JB, et al. Variables associated with a poor prognosis in patients with an ischemic thallium-201 exercise test. Am Heart J 1993; 125:335.
  19. Lauer MS, Mehta R, Pashkow FJ, et al. Association of chronotropic incompetence with echocardiographic ischemia and prognosis. J Am Coll Cardiol 1998; 32:1280.
  20. Iskandrian AS, Heo J, Kong B, Lyons E. Effect of exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients. J Am Coll Cardiol 1989; 14:1477.
  21. Heller GV, Ahmed I, Tilkemeier PL, et al. Influence of exercise intensity on the presence, distribution, and size of thallium-201 defects. Am Heart J 1992; 123:909.
  22. Heller GV, Ahmed I, Tilkemeier PL, et al. Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable angina pectoris. Am J Cardiol 1991; 68:569.
  23. Steele P, Sklar J, Kirch D, et al. Thallium-201 myocardial imaging during maximal and submaximal exercise: comparison of submaximal exercise with propranolol. Am Heart J 1983; 106:1353.
  24. Shehata AR, Gillam LD, Mascitelli VA, et al. Impact of acute propranolol administration on dobutamine-induced myocardial ischemia as evaluated by myocardial perfusion imaging and echocardiography. Am J Cardiol 1997; 80:268.
  25. Navare SM, Katten D, Johnson LL, et al. Risk stratification with electrocardiographic-gated dobutamine stress technetium-99m sestamibi single-photon emission tomographic imaging: value of heart rate response and assessment of left ventricular function. J Am Coll Cardiol 2006; 47:781.
  26. Sicari R, Cortigiani L, Bigi R, et al. Prognostic value of pharmacological stress echocardiography is affected by concomitant antiischemic therapy at the time of testing. Circulation 2004; 109:2428.
  27. Brown KA, Rowen M. Impact of antianginal medications, peak heart rate and stress level on the prognostic value of a normal exercise myocardial perfusion imaging study. J Nucl Med 1993; 34:1467.
  28. In: Imaging Guidelines for Nuclear Cardiology Procedures. A Report of The American Society of Nuclear Cardiology Quality Assurance Committee. DePuey EG (Ed), American Society of Nuclear Cardiology 2006.
  29. Moir TW. Subendocardial distribution of coronary blood flow and the effect of antianginal drugs. Circ Res 1972; 30:621.
  30. Jackson G, Atkinson L, Oram S. Improvement of myocardial metabolism in coronary arterial disease by beta-blockade. Br Heart J 1977; 39:829.
  31. Kern MJ, Ganz P, Horowitz JD, et al. Potentiation of coronary vasoconstriction by beta-adrenergic blockade in patients with coronary artery disease. Circulation 1983; 67:1178.
  32. Vatner SF, Hintze TH. Mechanism of constriction of large coronary arteries by beta-adrenergic receptor blockade. Circ Res 1983; 53:389.
  33. Picano E. Dipyridamole-echocardiography test: historical background and physiologic basis. Eur Heart J 1989; 10:365.
  34. Taillefer R, Ahlberg AW, Masood Y, et al. Acute beta-blockade reduces the extent and severity of myocardial perfusion defects with dipyridamole Tc-99m sestamibi SPECT imaging. J Am Coll Cardiol 2003; 42:1475.
  35. Vatner SF, Hintze TH, Macho P. Regulation of large coronary arteries by beta-adrenergic mechanisms in the conscious dog. Circ Res 1982; 51:56.
  36. Hodgson JM, Cohen MD, Szentpetery S, Thames MD. Effects of regional alpha- and beta-blockade on resting and hyperemic coronary blood flow in conscious, unstressed humans. Circulation 1989; 79:797.
  37. Ferro A, Kaumann AJ, Brown MJ. Beta-adrenoceptor subtypes in human coronary artery: desensitization of beta 2-adrenergic vasorelaxation by chronic beta 1-adrenergic stimulation in vitro. J Cardiovasc Pharmacol 1995; 25:134.
  38. Egstrup K, Andersen PE Jr. Transient myocardial ischemia during nifedipine therapy in stable angina pectoris, and its relation to coronary collateral flow and comparison with metoprolol. Am J Cardiol 1993; 71:177.
  39. Jorgensen CR, Wang K, Wang Y, et al. Effect of propranolol on myocardial oxygen consumption and its hemodynamic correlates during upright exercise. Circulation 1973; 48:1173.
  40. Ellestad M. Stress Testing Principles and Practice, Oxford University Press, Inc, New York 2003.
  41. Hockings B, Saltissi S, Croft DN, Webb-Peploe MM. Effect of beta adrenergic blockade on thallium-201 myocardial perfusion imaging. Br Heart J 1983; 49:83.
  42. Martin GJ, Henkin RE, Scanlon PJ. Beta blockers and the sensitivity of the thallium treadmill test. Chest 1987; 92:486.
  43. Narahara KA, Thompson CJ, Hazen JF, et al. The effect of beta blockade on single photon emission computed tomographic (SPECT) thallium-201 images in patients with coronary disease. Am Heart J 1989; 117:1030.
  44. Reyes E, Stirrup J, Roughton M, et al. Attenuation of adenosine-induced myocardial perfusion heterogeneity by atenolol and other cardioselective beta-adrenoceptor blockers: a crossover myocardial perfusion imaging study. J Nucl Med 2010; 51:1036.
  45. Camarozano AC, Siqueira-Filho AG, Weitzel LH, et al. The effects of early administration of atropine during dobutamine stress echocardiography: advantages and disadvantages of early dobutamine-atropine protocol. Cardiovasc Ultrasound 2006; 4:17.
  46. Ling LH, Pellikka PA, Mahoney DW, et al. Atropine augmentation in dobutamine stress echocardiography: role and incremental value in a clinical practice setting. J Am Coll Cardiol 1996; 28:551.
  47. Chen L, Ma L, de Prada VA, et al. Effects of beta-blockade and atropine on ischemic responses in left ventricular regions subtending coronary stenosis during dobutamine stress echocardiography. J Am Coll Cardiol 1996; 28:1866.
  48. Follath F. The role of calcium antagonists in the treatment of myocardial ischemia. Am Heart J 1989; 118:1093.
  49. Pepine CJ, Lambert CR. Effects of nicardipine on coronary blood flow. Am Heart J 1988; 116:248.
  50. Chaffman M, Brogden RN. Diltiazem. A review of its pharmacological properties and therapeutic efficacy. Drugs 1985; 29:387.
  51. Moskowitz RM, Piccini PA, Nacarelli GV, Zelis R. Nifedipine therapy for stable angina pectoris: preliminary results of effects on angina frequency and treadmill exercise response. Am J Cardiol 1979; 44:811.
  52. Fox KM, Deanfield J, Jonathan A, Selwyn A. The dose-response effects of nifedipine of ST-segment changes in exercise testing: preliminary studies. Cardiology 1981; 68 Suppl 2:209.
  53. Rice KR, Gervino E, Jarisch WR, Stone PH. Effects of nifedipine on myocardial perfusion during exercise in chronic stable angina pectoris. Am J Cardiol 1990; 65:1097.
  54. Dodi C, Pingitore A, Sicari R, et al. Effects of antianginal therapy with a calcium antagonist and nitrates on dobutamine-atropine stress echocardiography. Comparison with exercise electrocardiography. Eur Heart J 1997; 18:242.
  55. Sharir T, Rabinowitz B, Livschitz S, et al. Underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium-201 single-photon emission computed tomographic myocardial perfusion imaging in patients taking antianginal drugs. J Am Coll Cardiol 1998; 31:1540.
  56. Hintze TH, Vatner SF. Comparison of effects of nifedipine and nitroglycerin on large and small coronary arteries and cardiac function in conscious dogs. Circ Res 1983; 52:I139.
  57. Nagao T, Murata S, Sato M. Effects of diltiazem (CRD-401) on developed coronary collaterals in the dog. Jpn J Pharmacol 1975; 25:281.
  58. Fallen EL, Nahmias C, Scheffel A, et al. Redistribution of myocardial blood flow with topical nitroglycerin in patients with coronary artery disease. Circulation 1995; 91:1381.
  59. Wayne VS, Fagan ET, McConachy DL. The Effects of Isosorbide Dinitrate on the Exercise Test. J Cardiopulm Rehabil Prev 1987; 7:239.
  60. Mahmarian JJ, Fenimore NL, Marks GF, et al. Transdermal nitroglycerin patch therapy reduces the extent of exercise-induced myocardial ischemia: results of a double-blind, placebo-controlled trial using quantitative thallium-201 tomography. J Am Coll Cardiol 1994; 24:25.
  61. Tono I, Satoh S, Kanaya T, et al. Alterations in myocardial perfusion during exercise after isosorbide dinitrate infusion in patients with coronary disease: assessment by thallium-201 scintigraphy. Am Heart J 1986; 111:525.
  62. Sudhir K, Chou TM, Hutchison SJ, Chatterjee K. Coronary vasodilation induced by angiotensin-converting enzyme inhibition in vivo: differential contribution of nitric oxide and bradykinin in conductance and resistance arteries. Circulation 1996; 93:1734.
  63. Kitakaze M, Minamino T, Node K, et al. Beneficial effects of inhibition of angiotensin-converting enzyme on ischemic myocardium during coronary hypoperfusion in dogs. Circulation 1995; 92:950.
  64. Ertl G, Kloner RA, Alexander RW, Braunwald E. Limitation of experimental infarct size by an angiotensin-converting enzyme inhibitor. Circulation 1982; 65:40.
  65. Mancini GB, Henry GC, Macaya C, et al. Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND (Trial on Reversing ENdothelial Dysfunction) Study. Circulation 1996; 94:258.
  66. Anderson TJ, Elstein E, Haber H, Charbonneau F. Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study). J Am Coll Cardiol 2000; 35:60.
  67. Perondi R, Saino A, Tio RA, et al. ACE inhibition attenuates sympathetic coronary vasoconstriction in patients with coronary artery disease. Circulation 1992; 85:2004.
  68. Kiowski W, Zuber M, Elsasser S, et al. Coronary vasodilatation and improved myocardial lactate metabolism after angiotensin converting enzyme inhibition with cilazapril in patients with congestive heart failure. Am Heart J 1991; 122:1382.
  69. Schneider CA, Voth E, Moka D, et al. Improvement of myocardial blood flow to ischemic regions by angiotensin-converting enzyme inhibition with quinaprilat IV: a study using [15O] water dobutamine stress positron emission tomography. J Am Coll Cardiol 1999; 34:1005.
  70. van den Heuvel AF, Dunselman PH, Kingma T, et al. Reduction of exercise-induced myocardial ischemia during add-on treatment with the angiotensin-converting enzyme inhibitor enalapril in patients with normal left ventricular function and optimal beta blockade. J Am Coll Cardiol 2001; 37:470.
  71. Longobardi G, Ferrara N, Leosco D, et al. Failure of protective effect of captopril and enalapril on exercise and dipyridamole-induced myocardial ischemia. Am J Cardiol 1995; 76:255.
  72. Benndorf RA, Appel D, Maas R, et al. Telmisartan improves endothelial function in patients with essential hypertension. J Cardiovasc Pharmacol 2007; 50:367.
  73. Tomás JP, Moya JL, Barrios V, et al. Effect of candesartan on coronary flow reserve in patients with systemic hypertension. J Hypertens 2006; 24:2109.
  74. Higuchi T, Abletshauser C, Nekolla SG, et al. Effect of the angiotensin receptor blocker Valsartan on coronary microvascular flow reserve in moderately hypertensive patients with stable coronary artery disease. Microcirculation 2007; 14:805.
  75. Henzlova MJ, Cerqueira MD, Mahmarian JJ, et al. Stress protocols and tracers. J Nucl Cardiol 2006; 13:e80.
  76. Costill DL, Dalsky GP, Fink WJ. Effects of caffeine ingestion on metabolism and exercise performance. Med Sci Sports 1978; 10:155.
  77. Ivy JL, Costill DL, Fink WJ, Lower RW. Influence of caffeine and carbohydrate feedings on endurance performance. Med Sci Sports 1979; 11:6.
  78. Bruce CR, Anderson ME, Fraser SF, et al. Enhancement of 2000-m rowing performance after caffeine ingestion. Med Sci Sports Exerc 2000; 32:1958.
  79. Schneiker KT, Bishop D, Dawson B, Hackett LP. Effects of caffeine on prolonged intermittent-sprint ability in team-sport athletes. Med Sci Sports Exerc 2006; 38:578.
  80. Am J Clin Nutr 1980; 33:989.
  81. Barbour MM, Garber CE, Ahlberg AW, et al. Effects of intravenous theophylline on exercise-induced myocardial ischemia: II. A concentration-dependent phenomenon. J Am Coll Cardiol 1993; 22:1155.
  82. Heller GV, Barbour MM, Dweik RB, et al. Effects of intravenous theophylline on exercise-induced myocardial ischemia. I. Impact on the ischemic threshold. J Am Coll Cardiol 1993; 21:1075.
  83. Smits P, Boekema P, De Abreu R, et al. Evidence for an antagonism between caffeine and adenosine in the human cardiovascular system. J Cardiovasc Pharmacol 1987; 10:136.
  84. Granato JE, Watson DD, Belardinelli L, et al. Effects of dipyridamole and aminophylline on hemodynamics, regional myocardial blood flow and thallium-201 washout in the setting of a critical coronary stenosis. J Am Coll Cardiol 1990; 16:1760.
  85. Smits P, Aengevaeren WR, Corstens FH, Thien T. Caffeine reduces dipyridamole-induced myocardial ischemia. J Nucl Med 1989; 30:1723.
  86. Smits P, Corstens FH, Aengevaeren WR, et al. False-negative dipyridamole-thallium-201 myocardial imaging after caffeine infusion. J Nucl Med 1991; 32:1538.
  87. Heller GV, Dweik RB, Barbour MM, et al. Pretreatment with theophylline does not affect adenosine-induced thallium-201 myocardial imaging. Am Heart J 1993; 126:1077.
  88. Zoghbi GJ, Htay T, Aqel R, et al. Effect of caffeine on ischemia detection by adenosine single-photon emission computed tomography perfusion imaging. J Am Coll Cardiol 2006; 47:2296.
  89. Gaemperli O, Schepis T, Koepfli P, et al. Interaction of caffeine with regadenoson-induced hyperemic myocardial blood flow as measured by positron emission tomography: a randomized, double-blind, placebo-controlled crossover trial. J Am Coll Cardiol 2008; 51:328.
  90. Tejani FH, Thompson RC, Iskandrian AE, et al. Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: rationale and design of a prospective, randomized, multicenter study. J Nucl Cardiol 2011; 18:73.
  91. Rod JL, Shenasa M. Functional significance of chronotropic response during chronic amiodarone therapy. Cardiology 1984; 71:40.
  92. Remme WJ, Van Hoogenhuyze DC, Krauss XH, et al. Acute hemodynamic and antiischemic effects of intravenous amiodarone. Am J Cardiol 1985; 55:639.
  93. Pfisterer M, Burkart F. Effect of short and long term administration of amiodarone on ischaemia-induced left ventricular dysfunction. Implications for combined antianginal drug therapy. Drugs 1985; 29 Suppl 3:23.
  94. Holt DW, Tucker GT, Jackson PR, Storey GC. Amiodarone pharmacokinetics. Am Heart J 1983; 106:840.
  95. Thorne S, Mullen MJ, Clarkson P, et al. Early endothelial dysfunction in adults at risk from atherosclerosis: different responses to L-arginine. J Am Coll Cardiol 1998; 32:110.
  96. Egashira K, Hirooka Y, Kuga T, et al. Effects of L-arginine supplementation on endothelium-dependent coronary vasodilation in patients with angina pectoris and normal coronary arteriograms. Circulation 1996; 94:130.
  97. Ceremuzyński L, Chamiec T, Herbaczyńska-Cedro K. Effect of supplemental oral L-arginine on exercise capacity in patients with stable angina pectoris. Am J Cardiol 1997; 80:331.
  98. Egashira K, Hirooka Y, Kai H, et al. Reduction in serum cholesterol with pravastatin improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia. Circulation 1994; 89:2519.
  99. Boodhwani M, Nakai Y, Voisine P, et al. High-dose atorvastatin improves hypercholesterolemic coronary endothelial dysfunction without improving the angiogenic response. Circulation 2006; 114:I402.
  100. Jones SP, Gibson MF, Rimmer DM 3rd, et al. Direct vascular and cardioprotective effects of rosuvastatin, a new HMG-CoA reductase inhibitor. J Am Coll Cardiol 2002; 40:1172.
  101. Laufs U, La Fata V, Plutzky J, Liao JK. Upregulation of endothelial nitric oxide synthase by HMG CoA reductase inhibitors. Circulation 1998; 97:1129.
  102. Treasure CB, Klein JL, Weintraub WS, et al. Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease. N Engl J Med 1995; 332:481.
  103. Eichstädt HW, Eskötter H, Hoffman I, et al. Improvement of myocardial perfusion by short-term fluvastatin therapy in coronary artery disease. Am J Cardiol 1995; 76:122A.
  104. Eichstädt HW, Abletshauser CB, Störk T, Weidinger G. Beneficial effects of fluvastatin on myocardial blood flow at two time-points in hypercholesterolemic patients with coronary artery disease. J Cardiovasc Pharmacol 2000; 35:735.
  105. Manfrini O, Pizzi C, Morgagni G, et al. Effect of pravastatin on myocardial perfusion after percutaneous transluminal coronary angioplasty. Am J Cardiol 2004; 93:1391.
  106. Hosokawa R, Nohara R, Linxue L, et al. Effect of long-term cholesterol-lowering treatment with HMG-CoA reductase inhibitor (simvastatin) on myocardial perfusion evaluated by thallium-201 single photon emission computed tomography. Jpn Circ J 2000; 64:177.
  107. Schwartz RG, Pearson TA, Kalaria VG, et al. Prospective serial evaluation of myocardial perfusion and lipids during the first six months of pravastatin therapy: coronary artery disease regression single photon emission computed tomography monitoring trial. J Am Coll Cardiol 2003; 42:600.
  108. Gould KL, Martucci JP, Goldberg DI, et al. Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease. A potential noninvasive marker of healing coronary endothelium. Circulation 1994; 89:1530.
  109. Indolfi C, Piscione F, Russolillo E, et al. Digoxin-induced vasoconstriction of normal and atherosclerotic epicardial coronary arteries. Am J Cardiol 1991; 68:1274.
  110. Sketch MH, Mooss AN, Butler ML, et al. Digoxin-induced positive exercise tests: their clinical and prognostic significance. Am J Cardiol 1981; 48:655.
  111. Nasrallah AT, Garcia E, Benry J, Hall RJ. Treadmill exercise testing in the presence of digitals therapy or nonspecific ST-T changes: correlation with coronary angiography. Cathet Cardiovasc Diagn 1975; 1:375.
  112. Rovang KS, Arouni AJ, Mohiuddin SM, et al. Effect of estrogen on exercise electrocardiograms in healthy postmenopausal women. Am J Cardiol 2000; 86:477.
  113. Clark PI, Glasser SP, Lyman GH, et al. Relation of results of exercise stress tests in young women to phases of the menstrual cycle. Am J Cardiol 1988; 61:197.
  114. Jaffe MD. Effect of oestrogens on postexercise electrocardiogram. Br Heart J 1976; 38:1299.
  115. Marmor A, Zeira M, Zohar S. Effects of bilateral hystero-salpingo-oophorectomy on exercise-induced ST-segment abnormalities in young women. Am J Cardiol 1993; 71:1118.
  116. Henzlova MJ, Croft LB, Diamond JA. Effect of hormone replacement therapy on the electrocardiographic response to exercise. J Nucl Cardiol 2002; 9:385.
  117. Surawicz B. Relationship between electrocardiogram and electrolytes. Am Heart J 1967; 73:814.
  118. Pascual EE, Cintron GB, Valdez MG, Clark PI. Effect of diuretic therapy on the electrocardiographic response to exercise. Clin Cardiol 1992; 15:93.