However, an exercise stress test may provide more information about exercise tolerance than a pharmacologic stress test.Commonly used agents include:

Vasodilators acting as adenosine receptor agonists, such as adenosine itself, and dipyridamole (brand name "Persantine"), which acts indirectly at the receptor. Regadenoson (brand name "Lexiscan"), which acts specifically at the adenosine A2A receptor, thus affecting the heart more than the lung. Dobutamine. The effects of beta-agonists such as dobutamine can be reversed by administering beta-blockers such as propranolol.Lexiscan (Regadenoson) or Dobutamine is often used in patients with severe reactive airway disease (asthma or COPD) as adenosine and dipyridamole can cause acute exacerbation of these conditions. If the patients Asthma is treated with an inhaler then it should be used as a pre-treatment prior to the injection of the pharmacologic stress agent. In addition, if the patient is actively wheezing then the physician should determine the benefits versus the risk to the patient of performing a stress test especially outside of a hospital setting. Caffeine is usually held 24 hours prior to an adenosine stress test, as it is a competitive antagonist of the A2A adenosine receptor and can attenuate the vasodilatory effects of adenosine.Aminophylline may be used to attenuate severe and/or persistent adverse reactions to Adenosine and Lexiscan. Limitations
The stress test does not detect:
Atheroma
Vulnerable plaquesThe test has relatively high rates of false positives and false negatives compared with other clinical tests. Females in particular have a higher rate of false positives, which is theorized to be because on average they have smaller hearts.
In 2013, in its "Exercise Standards for Testing and Training", the AHA indicated that high frequency QRS analysis during ECG treadmill test have useful test performance for detection of coronary heart disease. Perfusion stress test (with 99mTc labelled sestamibi) is appropriate for select patients, especially those with an abnormal resting electrocardiogram. Intracoronary ultrasound or angiogram can provide more information at the risk of complications associated with cardiac catheterization. Diagnostic value
The common approach for stress testing by American College of Cardiology and American Heart Association indicates the following:
Treadmill test: sensitivity 73-90%, specificity 50-74% (modified Bruce protocol)
Nuclear test: sensitivity 81%, specificity 85-95%(Sensitivity is the percentage of people with the condition who are correctly identified by the test as having the condition; specificity is the percentage of people without the condition are correctly identified by the test as not having the condition). To arrive at the patients posttest likelihood of disease, interpretation of the stress test result requires integration of the patients pretest likelihood with the tests sensitivity and specificity. This approach, first described by Diamond and Forrester in the 1970s, results in an estimate of the patients post-test likelihood of disease. The value of stress tests has always been recognized as limited in assessing heart disease such as atherosclerosis, a condition which mainly produces wall thickening and enlargement of the arteries.