Excerpt

Aortic stenosis often coexists with coronary atherosclerotic disease, and with the exception of men less than 40 years old and premenopausal women, part of the workup in clinical practice includes assessment for coronary disease. Conversely, the presence of angina in patients with aortic stenosis is less specific for coronary obstructive disease, since chest pain could be a result of increased myocardial wall stress, increased oxygen demand, or subendocardial ischemia. According to the guidelines, ischemic workup should be preferably performed using coronary angiography, since exercise stress testing has been traditionally considered a contraindication for symptomatic1 and even asymptomatic2 severe aortic stenosis. Vasodilator stress single photon emission computed tomography (SPECT) or positron emission tomography (PET) imaging could also provide valuable information about the presence of coronary ischemia in this patient population; however, the acute systemic vasodilatory effect of adenosine, dipyridamole , and regadenoson has been rightfully causing disquiet among this population. Therefore, the safety, and the diagnostic and prognostic significances of vasodilator stress imaging have not been well studied in aortic stenosis and are not well established. …