Pharmacologic myocardial perfusion stress tests. Adenosine thallium stress test.
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Abstract:
Thallium-201 myocardial perfusion scintigraphy assists in detecting coronary artery disease and assessing the significance of known stenoses. An adenosine infusion protocol is discussed in conjunction with presentation of results obtained in a community hospital setting. Primary indications for pharmacologic stress maneuvers include: Evaluation of patients unable or unwilling to exercise to adequate levels of workload and patients undergoing preoperative evaluation (particularly in patients undergoing vascular surgery). Experience in a community hospital setting attests to the safety of this pharmacologic protocol while showing a diagnostic accuracy similar to results reported in peer review literature. The method has been readily received by referring internists and cardiologists and is associated with a 21% increase in nuclear myocardial perfusion stress tests during the first six months of 1991.Keywords:
Stress testing (software)
Thallium
Myocardial perfusion scintigraphy
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Dipyridamole
Thallium
Myocardial perfusion scintigraphy
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Pharmacologic coronary vasodilation in conjunction with myocardial scintigraphy has become an accepted alternative to dynamic exercise testing for the diagnosis of coronary artery disease. Although dipyridamole has traditionally been used for this purpose, it causes frequent side effect, which at times can be life-threatening. Moreover, dipyridamole dose not elicit maximal coronary vasodilation in a substantial number of patients receiving the usual i.v. dose. Adenosine is an endogenously produced compound that has significant effects as a coronary vasodilator and rapid onset action and extremely short half-life ( myocardial scintigraphy were evaluated and comparison with exercise was performed. Twenty-eight subjects underwent imaging after adenosine infusion and exercise imaging. Adenosine was infused intravenously at a dose of 0.14mg/kg/body weight per minute for 6 min and MIBI was injected at 3 minute. Adenosine caused an incerease in heart rate ( at baseline versus beats/min at peak effect, p 1 mm) and second degree AV block in electrocardiography occured in 11% of the patients, respectively. The overall sensitivity and specificity for individual coronary stenoses in 16 patients underwent coronary angiography were 88% and 95%, respectively. The agreement ratio of segmental perfusion between adenosine and exercise images was 92% (Kappa index=0.82). In conclusion, myocardial perfusion scintigraphy with intravenous adenosine is a feasible, safe and highly accurate noninvasive technique for the detection of coronary artery disease and results are at least comparable with those of exercise scintigraphy.
Dipyridamole
Myocardial perfusion scintigraphy
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Objective To evaluate the accuracy and safety of domestic-made adenosine in 99mTc-methoxyisobutylisonitrle(MIBI)myocardial perfusion SPECT/CT during adenosine stress for the diagnosis of myocardial ischemia.Methods Sixty patients with suspected coronary artery disease underwent adenosine stress and rest myocardial perfusion imaging.Adenosine was infused intravenously at a constant rate of 0.14 mg/kg·min for 6 min.At the end of 3 min,925MBq of 99mTc-MIBI was injected.Results Adenosine stress myocardial perfusion scintigraphy was abnormal in 48 out of the 60 patients.The positive rate was 80%.The frequency of side effects was slight and transient with the incidence of 80%(48/60).Conclusions The domestic-made adenosine in stress myocardial perfusion imaging is safe and sensitive for detecting myocardial ischemia.
Myocardial perfusion scintigraphy
Dipyridamole
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The clinical applications of nuclear cardiology have rapidly expanded since the introduc tion of suitable imaging cameras and readily applicable isotopes. The currently available methods can provide useful data on estimates of ventricular function and detection of myocardial ischemia for adequate patient management. Two standard procedures are routinely used: (1) myocardial perfusion scintigraphy, eg, with thallium 201; and (2) radionuclide angiocardiography by using technetium 99m-labeled red blood cells. Myocardial perfusion scintigraphy provides information on regional viability and estimates regional myocardial perfusion by measuring regional tracer activity. Thallium 201 is the agent used for noninvasive assessment of myocardial perfusion and for improving the results of exercise electrocardiography. Alternative tests, such as pharmacologic stress testing with dipyridamole, have been proposed as a reliable substitute for exercise testing. Additional quantitative analysis and computed tomography have increased the sensi tivity and specificity of thallium scintigraphy. Radionuclide angiography techniques are used for the noninvasive evaluation of cardiac function, right and left ventricular function, and wall motion abnormalities. As in perfusion scintigraphy, radionuclide angiography has proven its value for the detection of coronary artery disease (CAD). Abnormal regional wall motion abnormalities are specific for CAD.
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Thallium
Myocardial perfusion scintigraphy
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Pharmacologic stress testing with dipyridamole is useful in patients undergoing thallium-201 myocardial perfusion scintigraphy who cannot adequately exercise. Because dipyridamole increases coronary blood flow by reducing the metabolism of adenosine, the authors compared the uptake and clearance of T1-201 following exercise stress testing (EST) and resting intravenous infusion of adenosine (AI) in crossover fashion in 20 healthy men. No perfusion defects or areas of redistribution were noted in any of the scans. Mean absolute myocardial T1-201 uptake was 1.3 times greater with AI than with EST. Mean absolute extracardiac uptake was 2.0 times greater with AI. Mean T1-201 myocardial clearance was virtually the same in all AI and EST views. During AI, 70% of the subjects experienced subjective side effects, mean arterial blood pressure decreased by 15%, and heart rate increased by 48%. The effects of adenosine on T1-201 kinetics in the myocardium are similar to those of EST. Adenosine may be useful as a pharmacologic stress agent in patients undergoing T1-201 myocardial perfusion scintigraphy.
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Myocardial perfusion scintigraphy
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Crossover study
Thallium
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Dipyridamole
Coronary vasodilator
Myocardial perfusion scintigraphy
Coronary steal
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Thallium
Dipyridamole
Coronary vasodilator
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Myocardial scintigraphy was performed three times in a 55-year-old woman with left bundle branch block (LBBB). A significant LAD stenosis had been excluded by coronary angiography. The first scintigraphy was performed with Tc-99m sestamibi after submaximal bicycle exercise and revealed a septal perfusion deficit. This deficit could not be reproduced in the following examinations after pharmacological stress testing with dipyridamole using both Tl-201 and Tc-99m sestamibi. Perfusion at rest assessed with Tl-201 was normal in all studies. It is concluded that pharmacological stress testing with dipyridamole is to be preferred in patients with LBBB. With respect to the accuracy of myocardial perfusion imaging the choice of the radiopharmaceutical plays a less important role.
Dipyridamole
Myocardial perfusion scintigraphy
Stress testing (software)
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Dipyridamole
Thallium
Stress testing (software)
Spect imaging
Technetium (99mTc) sestamibi
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Citations (38)