Exercise Requirements for Cardiac PET Scans

Cardiac PET Imaging: Tracer-Specific Protocols

The American Heart Association recommends that Rb-82 PET imaging can only be performed with pharmacological stress because the tracer has an extremely short half-life that makes exercise stress technically impossible 1, 2
The American College of Cardiology suggests that pharmacologic agents used for Rb-82 PET imaging include adenosine, regadenoson, or dipyridamole 1
The European Society of Cardiology states that N-13 ammonia PET can be performed with either exercise or pharmacological stress, similar to SPECT protocols 1, 2

The American College of Cardiology recommends exercise stress for patients <65 years of age who can exercise 3
The European Society of Cardiology suggests that exercise stress is preferred when hemodynamic or symptomatic response to exercise is clinically important 3
The American Heart Association recommends that patients able to achieve ≥5 METs and 85% maximum predicted heart rate should undergo exercise stress 4, 5
The European Society of Cardiology states that pharmacologic stress is required for patients unable to exercise adequately 4, 5

The American College of Cardiology advises against performing stress PET imaging in patients with high-risk unstable angina, complicated acute coronary syndrome, or acute MI within 2 days 6
The European Society of Cardiology recommends avoiding stress PET imaging in patients with significant arrhythmias (ventricular tachycardia, second- or third-degree AV block) 6
The American Heart Association suggests that stress PET imaging is contraindicated in patients with significant hypotension (systolic BP <90 mmHg) 6
The European Society of Cardiology states that stress PET imaging is contraindicated in patients with uncontrolled heart failure 6
The American College of Cardiology recommends avoiding stress PET imaging in patients with sinus bradycardia <45 bpm 6

The American Heart Association reports that major complications from stress testing with PET are extremely rare (death <0.002%, MI <0.02%) 1