American Society of Nuclear Cardiology updates cardiac stress testing guideline
The American Society of Nuclear Cardiology (ASNC) has developed a new guideline for stress testing in single-photon emission computed tomography (SPECT) and positron emission tomography (PET) myocardial perfusion imaging. The document was built to provide updated recommendations on patient preparation, stressor selection, safety, modality specific protocols, image interpretation and reporting. It was published online in the Journal of Nuclear Cardiology.[1]
The “2026 ASNC Guideline for Stress Testing in SPECT and PET Myocardial Perfusion Imaging” replaces a 2016 guidance to reflect important changes in nuclear cardiology over the past decade.
“This updated clinical guideline is intended to serve as a single source of information for all aspects of stress testing, a comprehensive reference for exercise and pharmacologic stress,” Lane Duvall, MD, chair and lead author of the guideline, said in a statement. “The guideline provides what clinicians need for the preparation, performance, interpretation and reporting of stress testing.”
Among the big changes in nuclear cardiology is a shift from traditional SPECT imaging to wider use of PET because of its improved image quality and the additional information provided from myocardial flow reserve (MFR). ASNC announced earlier in 2026 PET is now the preferred modality when available. While SPECT remains a cornerstone of myocardial perfusion imaging, there has been a push for several years by ASNC for nuclear imaging departments to modernize, including a wider adoption of PET. This is now happening throughout the United States.
Key nuclear stress imaging guideline changes
Key updates in the 2026 guideline include new insights focused on SPECT- and PET-specific protocols, exercise PET, modality-specific instructions for individual stressor agents, radiotracer timing and myocardial blood flow assessments.
New patient preparation recommendations include avoiding caffeine and breastfeeding, better medication management and new patient pretest instructions.
Safety guidance has expanded with updated contraindications and “cautionary conditions," such as new recommendations for patients who have a seizure risk, when early termination of testing should be considered, and an individualized approach to choosing or changing the stress testing method.
There also are new standards for image interpretation and reporting. These updates include changes in exercise capacity, symptoms, ECG findings and heart rate and blood-pressure responses
According to ASNC, this document also includes discussions of emerging approaches, such as cold pressor and mental stress testing.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]