Document Detail


Comparison of adenosine and high-dose dipyridamole both combined with low-level exercise stress for 99Tcm-MIBI SPET myocardial perfusion imaging.
MedLine Citation:
PMID:  8778644     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Intravenously administered adenosine and high-dose dipyridamole, both combined with low-level exercise stress, were compared in a head-to-head fashion using 99Tcm-methoxyisobutyl isonitrile (99Tcm-MIBI) single photo emission tomography (SPET) myocardial perfusion imaging. Thirty-nine consecutive patients who had undergone coronary arteriography underwent 99Tcm-MIBI (740 Mbq) SPET after dipyridamole (0.84 mg kg-1) and after adenosine (0.84 mg kg-1), both combined with low-level exercise (30 W load), and under resting conditions. Our results demonstrate that adenosine and dipyridamole combined with exercise have comparable haemodynamic effects, with a low incidence of side-effects. The time of recovery from the stress protocol was not significantly different: adenosine, 5.7 +/- 3.9 min; dipyridamole, 6.6 +/- 4.9 min. However, aminophylline was significantly (P < 0.05) more often administered to reverse side-effects using the dipyridamole protocol (36% of patients) compared with the adenosine protocol (8% of patients). The results of 99Tcm-MIBI SPET imaging were highly concordant and demonstrated a high diagnostic accuracy for identifying coronary artery disease (CAD). The sensitivity was 90% (95% confidence intervals 79-100%) with adenosine SPET and 93% (95% confidence intervals 84-100%) with dipyridamole SPET for identifying patients with CAD (i.e. luminal stenosis > 50%); their specificities were both 100% (95% confidence intervals 66-100%). The sensitivity of identifying angiographically diseased vessels was 81% (95% confidence intervals 70-92%) using adenosine SPET and 85% (95% confidence intervals 75-95%) using dipyridamole; the specificity for both stress modalities was 94% (95% confidence intervals 89-100%). The combination of exercise with adenosine and high-dose dipyridamole appears to be a feasible and safe method to alleviate some of the undesirable A1-receptor-mediated side-effects of adenosine. The choice of the pharmacological stress will depend on local expertise and availability.
Authors:
M J Cramer; J F Verzijlbergen; E E van der Wall; P H Vermeersch; M G Niemeyer; A H Zwinderman; C A Ascoop; E K Pauwels
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Nuclear medicine communications     Volume:  17     ISSN:  0143-3636     ISO Abbreviation:  Nucl Med Commun     Publication Date:  1996 Feb 
Date Detail:
Created Date:  1996-09-19     Completed Date:  1996-09-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8201017     Medline TA:  Nucl Med Commun     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  97-104     Citation Subset:  IM    
Affiliation:
Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / administration & dosage,  adverse effects,  diagnostic use*
Adult
Aged
Clinical Protocols
Coronary Disease / radionuclide imaging
Dipyridamole / administration & dosage,  adverse effects,  diagnostic use*
Exercise Test / adverse effects,  methods
Female
Heart / radionuclide imaging*
Hemodynamics / drug effects
Humans
Injections, Intravenous
Male
Middle Aged
Safety
Technetium Tc 99m Sestamibi / administration & dosage,  diagnostic use*
Tomography, Emission-Computed, Single-Photon / methods*
Vasodilator Agents / administration & dosage,  adverse effects,  diagnostic use*
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 109581-73-9/Technetium Tc 99m Sestamibi; 58-32-2/Dipyridamole; 58-61-7/Adenosine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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