Document Detail


Pharmacologic stress perfusion imaging with adenosine: role of simultaneous low-level treadmill exercise.
MedLine Citation:
PMID:  11986564     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Adenosine is commonly used for pharmacologic stress myocardial perfusion imaging (MPI). However, it frequently results in adverse effects, and the subdiaphragmatic tracer uptake may interfere with the image interpretation. Our aim was to determine the feasibility of combining low-level treadmill exercise with adenosine MPI and its impact on adverse effects, image quality, and myocardial ischemia. METHODS AND RESULTS: Forty-one patients underwent technetium 99m sestamibi single photon emission computed tomography following adenosine and adenosine with low-level exercise (adenosine-Ex) on separate occasions and rest MPI. A comparison was made of symptoms, hemodynamic response, electrocardiographic changes, image quality, and image interpretation between the 2 protocols. With adenosine-Ex, fewer patients had one or more adverse effects (61% vs 90%; P =.006), more patients had ischemic electrocardiographic changes (34% vs 15%; P =.03), a higher percentage had excellent- or fair-quality images (88% vs 61%; P =.003), and they had higher heart-liver ratios (1.0 +/- 0.37 vs 0.84 +/- 0.29; P =.002) compared with adenosine alone. Four adenosine MPI studies, but only 2 adenosine-Ex studies, were uninterpretable because of excessive subdiaphragmatic radiotracer activity. Of the 39 patients with at least 1 interpretable stress study, interpretation was discordant in 11 (28%): 7 showed greater ischemia with adenosine-Ex, 2 uninterpretable adenosine studies were interpretable with adenosine-Ex, and 2 studies interpreted as abnormal with adenosine were normal by adenosine-Ex (both had normal coronary angiograms). CONCLUSIONS: Simultaneous low-level treadmill exercise with adenosine Tc-99m sestamibi imaging is safe and feasible, significantly reduces unfavorable side effects, enhances image quality, and may result in greater ischemia detection compared with adenosine alone.
Authors:
Habib Samady; Frans J Th Wackers; Tammy M Joska; Barry L Zaret; Diwakar Jain
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  9     ISSN:  1071-3581     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2002 Mar-Apr
Date Detail:
Created Date:  2002-05-02     Completed Date:  2002-08-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  188-96     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Medicine, University of Virginia Health Systems, Charlottesville, Va, USA.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / administration & dosage,  adverse effects,  diagnostic use*
Aged
Coronary Circulation
Coronary Disease / radionuclide imaging
Electrocardiography
Exercise Test
Female
Hemodynamics
Humans
Infusions, Intravenous
Male
Middle Aged
Myocardial Ischemia / radionuclide imaging*
Radiopharmaceuticals / diagnostic use
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon / methods*
Vasodilator Agents / administration & dosage,  adverse effects,  diagnostic use*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Vasodilator Agents; 109581-73-9/Technetium Tc 99m Sestamibi; 58-61-7/Adenosine

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


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