Skip to main content
SpringerLink
Log in

How Should We Stress the Human Heart?

  • Chapter
  • First Online:
From Basic Cardiac Imaging to Image Fusion

  • 1211 Accesses

Abstract

Cardiac stress testing, whether alone or combined with cardiac imaging, plays a major role in the diagnosis of coronary artery disease by provoking myocardial ischaemia and allowing the detection of myocardial perfusion abnormalities that arise from flow-limiting coronary stenosis. Cardiac stress imaging provides valuable diagnostic and prognostic information that guides clinical decision-making with regard to medical therapy and revascularisation. Dynamic exercise and pharmacological stress agents are used for this purpose with newly developed agents able to overcome some of the limitations of existing methods. Evidence shows that all current forms of stress are safe and have a similar diagnostic performance. With some exceptions, the selection of one form of stress over the others would mainly be dictated by patient characteristics and preferences, imaging technique and protocols, and local expertise and availability. Cardiac stress is an essential part of diagnostic imaging, and current practice relies on a number of methods that are equally effective for the detection of obstructive coronary artery disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Muller-Suur R, Eriksson SV, Strandberg LE, Mesko L (2001) Comparison of adenosine and exercise stress test for quantitative perfusion imaging in patients on beta-blocker therapy. Cardiology 95:112–118

    Article  PubMed  CAS  Google Scholar 

  2. Hayat SA, Dwivedi G, Jacobsen A, Lim TK, Kinsey C, Senior R (2008) Effects of left bundle-branch block on cardiac structure, function, perfusion, and perfusion reserve: implications for myocardial contrast echocardiography versus radionuclide perfusion imaging for the detection of coronary artery disease. Circulation 11:1832–1841

    Article  PubMed  CAS  Google Scholar 

  3. Loong CY, Anagnostopoulos C (2004) Diagnosis of coronary artery disease by radionuclide myocardial perfusion imaging. Heart 90:v2–v9

    Article  PubMed  Google Scholar 

  4. Gibbons RJ, Balady GJ, Bricker JT et al (2002) ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American heart association task force on practice guidelines (committee to update the 1997 exercise testing guidelines). Circulation 106:1883–1892

    Article  PubMed  Google Scholar 

  5. Fredholm BB, IJzerman AP, Jacobson KA, Klotz KN, Linden J (2001) International Union of Pharmacology. XXV. Nomenclature and classification of adenosine receptors. Pharmacol Rev 53: 527–552

    Google Scholar 

  6. Mubagwa K, Flameng W (2001) Adenosine, adenosine receptors and myocardial protection: an updated overview. Cardiovasc Res 52:25–39

    Article  PubMed  CAS  Google Scholar 

  7. Sato A, Terata K, Miura H et al (2005) Mechanism of vasodilation to adenosine in coronary arterioles from patients with heart disease. Am J Physiol Heart Circ Physiol 288:H1633–H1640

    Article  PubMed  CAS  Google Scholar 

  8. Lupi A, Buffon A, Finocchiaro ML, Conti E, Maseri A, Crea F (1997) Mechanisms of adenosine-induced epicardial coronary artery dilatation. Eur Heart J 18:614–617

    Article  PubMed  CAS  Google Scholar 

  9. Wilson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD (1990) Effects of adenosine on human coronary arterial circulation. Circulation 82:1595–1606

    Article  PubMed  CAS  Google Scholar 

  10. Moser GH, Schrader J, Deussen A (1989) Turnover of adenosine in plasma of human and dog blood. Am J Physiol 256(4 Pt 1):C799–C806

    PubMed  CAS  Google Scholar 

  11. Kaufmann PA, Gnecchi-Ruscone T, Di TM, Schafers KP, Luscher TF, Camici PG (2000) Coronary heart disease in smokers: vitamin C restores coronary microcirculatory function. Circulation 102:1233–1238

    Article  PubMed  CAS  Google Scholar 

  12. De BB, Pijls NH, Barbato E et al (2003) Intracoronary and intravenous adenosine 5′-triphosphate, adenosine, papaverine, and contrast medium to assess fractional flow reserve in humans. Circulation 107:1877–1883

    Article  Google Scholar 

  13. Akinboboye OO, Idris O, Chou RL, Sciacca RR, Cannon PJ, Bergmann SR (2001) Absolute quantitation of coronary steal induced by intravenous dipyridamole. J Am Coll Cardiol 37:109–116

    Article  PubMed  CAS  Google Scholar 

  14. Werner GS, Fritzenwanger M, Prochnau D et al (2006) Determinants of coronary steal in chronic total coronary occlusions donor artery, collateral, and microvascular resistance. J Am Coll Cardiol 48:51–58

    Article  PubMed  Google Scholar 

  15. Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS (1994) Safety profile of adenosine stress perfusion imaging: results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol 23:384–389

    Article  PubMed  CAS  Google Scholar 

  16. Mishra RK, Dorbala S, Logsetty G et al (2005) Quantitative relation between hemodynamic changes during intravenous adenosine infusion and the magnitude of coronary hyperemia: implications for myocardial perfusion imaging. J Am Coll Cardiol 45:553–558

    Article  PubMed  CAS  Google Scholar 

  17. Fredholm BB, Irenius E, Kull B, Schulte G (2001) Comparison of the potency of adenosine as an agonist at human adenosine receptors expressed in Chinese hamster ovary cells. Biochem Pharmacol 61:443–448

    Article  PubMed  CAS  Google Scholar 

  18. Shryock JC, Snowdy S, Baraldi PG et al (1998) A2A-Adenosine receptor reserve for coronary vasodilation. Circulation 98:711–718

    Article  PubMed  CAS  Google Scholar 

  19. Gao Z, Li Z, Baker SP et al (2001) Novel short-acting A2A adenosine receptor agonists for coronary vasodilation: inverse relationship between affinity and duration of action of A2A agonists. J Pharmacol Exp Ther 298:209–218

    PubMed  CAS  Google Scholar 

  20. Zablocki J, Palle V, Blackburn B et al (2001) 2-substituted pi system derivatives of adenosine that are coronary vasodilators acting via the A2A adenosine receptor. Nucleosides, Nucleotides Nucleic Acids 20:343–360

    Article  PubMed  CAS  Google Scholar 

  21. Lieu HD, Shryock JC, von Mering GO et al (2007) Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. J Nucl Cardiol 14:514–520

    Article  PubMed  Google Scholar 

  22. Reyes E, Staehr P, Olmsted A et al (2011) Effect of body mass index on the efficacy, side effect profile, and plasma concentration of fixed-dose regadenoson for myocardial perfusion imaging. J Nucl Cardiol 18:620–627

    Article  PubMed  Google Scholar 

  23. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE, On behalf of the ADVANCE-MPI Trial Investigators (2008) Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson Versus adenosine in myocardial perfusion imaging: integrated ADVANCE-MPI trial results. J Am Coll Cardiol Img 1:307-316

    Google Scholar 

  24. Dibella EV, Fluckiger JU, Chen L et al (2012) The effect of obesity on regadenoson-induced myocardial hyperemia: a quantitative magnetic resonance imaging study. Int J Cardiovasc Imaging 28:1435−1444

    Article  PubMed  Google Scholar 

  25. Gordi T, Blackburn B, Lieu H (2007) Regadenoson pharmacokinetics and tolerability in subjects with impaired renal function. J Clin Pharmacol 47:825–833

    Article  PubMed  CAS  Google Scholar 

  26. Gordi T, Frohna P, Sun HL, Wolff A, Belardinelli L, Lieu H (2006) A population pharmacokinetic/pharmacodynamic analysis of regadenoson, an adenosine A2A-receptor agonist, in healthy male volunteers. Clin Pharmacokinet 45:1201–1212

    Article  PubMed  CAS  Google Scholar 

  27. Iskandrian AE, Bateman TM, Belardinelli L et al (2007) Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 14:645–658

    Article  PubMed  Google Scholar 

  28. Dhalla AK, Wong MY, Wang WQ, Biaggioni I, Belardinelli L (2006) Tachycardia caused by A2A adenosine receptor agonists is mediated by direct sympathoexcitation in awake rats. J Pharmacol Exp Ther 316:695–702

    Article  PubMed  CAS  Google Scholar 

  29. Botvinick EH, Dae MW (1991) Dipyridamole perfusion scintigraphy. Semin Nucl Med 21:242–265

    Article  PubMed  CAS  Google Scholar 

  30. Rossen JD, Quillen JE, Lopez AG, Stenberg RG, Talman CL, Winniford MD (1991) Comparison of coronary vasodilation with intravenous dipyridamole and adenosine. J Am Coll Cardiol 18:485–491

    Article  PubMed  CAS  Google Scholar 

  31. Ranhosky A, Kempthorne-Rawson J (1990) The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Intravenous dipyridamole thallium imaging study group. Circulation 81:1205–1209

    Article  PubMed  CAS  Google Scholar 

  32. Reyes E, Stirrup J, Roughton M, D’Souza S, Underwood SR, Anagnostopoulos C (2010) Attenuation of adenosine-induced myocardial perfusion heterogeneity by atenolol and other cardioselective beta-adrenoceptor blockers: a crossover myocardial perfusion imaging study. J Nucl Med 51:1036–1043

    Article  PubMed  Google Scholar 

  33. Taillefer R, Ahlberg AW, Masood Y et al (2003) Acute beta-blockade reduces the extent and severity of myocardial perfusion defects with dipyridamole Tc-99 m sestamibi SPECT imaging. J Am Coll Cardiol 42:1475–1483

    Article  PubMed  CAS  Google Scholar 

  34. Sharir T, Rabinowitz B, Livschitz S et al (1998) Underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium-201 single-photon emission computed tomographic myocardial perfusion imaging in patients taking antianginal drugs. J Am Coll Cardiol 31:1540–1546

    Article  PubMed  CAS  Google Scholar 

  35. Anagnostopoulos C, Harbinson M, Kelion A et al (2004) Procedure guidelines for radionuclide myocardial perfusion imaging. Heart 90(Suppl 1):i1–10

    Article  PubMed  Google Scholar 

  36. Henzlova M, Cerqueira MD, Hansen C, Taileffer R, Siu-Sun Y (2009) ASNC imaging guidelines for nuclear cardiology procedures: stress protocols and tracers. In: American society of nuclear cardiology (ASNC) 2009 at http://www.asnc.org/section_73.cfm. 01/02/2010

  37. Gaemperli O, Schepis T, Koepfli P et al (2008) Interaction of caffeine with regadenoson-induced hyperemic myocardial blood flow as measured by positron emission tomography: a randomized, double-blind, placebo-controlled crossover trial. J Am Coll Cardiol 51:328–329

    Article  PubMed  Google Scholar 

  38. Tejani FH, Thompson RC, Iskandrian AE, McNutt BE, Franks B (2011) Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: rationale and design of a prospective, randomized, multicenter study. J Nucl Cardiol 18:73–81

    Article  PubMed  Google Scholar 

  39. O’Keefe JH Jr, Bateman TM, Handlin LR, Barnhart CS (1995) Four- versus 6-minute infusion protocol for adenosine thallium-201 single photon emission computed tomography imaging. Am Heart J 129:482–487

    Article  PubMed  Google Scholar 

  40. Villegas BJ, Hendel RC, Dahlberg ST, McSherry BA, Leppo JA (1993) Comparison of 3- versus 6-minute infusions of adenosine in thallium-201 myocardial perfusion imaging. Am Heart J 126:103–107

    Article  PubMed  CAS  Google Scholar 

  41. Treuth MG, Reyes GA, He ZX, Cwajg E, Mahmarian JJ, Verani MS (2001) Tolerance and diagnostic accuracy of an abbreviated adenosine infusion for myocardial scintigraphy: a randomized, prospective study. J Nucl Cardiol 8:548–554

    Article  PubMed  CAS  Google Scholar 

  42. Pennell DJ, Mavrogeni SI, Forbat SM, Karwatowski SP, Underwood SR (1995) Adenosine combined with dynamic exercise for myocardial perfusion imaging. J Am Coll Cardiol 25:1300–1309

    Article  PubMed  CAS  Google Scholar 

  43. Thomas GS, Prill NV, Majmundar H et al (2000) Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality. J Nucl Cardiol 7:439–446

    Article  PubMed  CAS  Google Scholar 

  44. Reyes E, Wiener S, Underwood SR (2012) Myocardial perfusion scintigraphy in Europe 2007: a survey of the European council of nuclear cardiology. Eur J Nucl Med Mol Imaging 39:160–164

    Article  PubMed  Google Scholar 

  45. Reyes E, Loong CY, Wechalekar K, Latus K, Anagnostopoulos C, Underwood SR (2007) Side effect profile and tolerability of adenosine myocardial perfusion scintigraphy in patients with mild asthma or chronic obstructive pulmonary disease. J Nucl Cardiol 14:827–834

    Article  PubMed  Google Scholar 

  46. Sundram F, Notghi A, Smith NB (2009) Pharmacological stress myocardial perfusion scintigraphy: use of a modified adenosine protocol in patients with asthma. Nucl Med Commun 30:217–225

    Article  PubMed  Google Scholar 

  47. Reyes E, Loong CY, Harbinson M, Donovan J, Anagnostopoulos C, Underwood SR (2008) High-dose adenosine overcomes the attenuation of myocardial perfusion reserve caused by caffeine. J Am Coll Cardiol 52:2008–2016

    Article  PubMed  CAS  Google Scholar 

  48. Thomas GS, Thompson RC, Miyamoto MI et al (2009) The RegEx trial: a randomized, double-blind, placebo- and active-controlled pilot study combining regadenoson, a selective A(2A) adenosine agonist, with low-level exercise, in patients undergoing myocardial perfusion imaging. J Nucl Cardiol 16:63–72

    Article  PubMed  Google Scholar 

  49. Mahmarian JJ, Cerqueira MD, Iskandrian AE et al (2009) Regadenoson induces comparable left ventricular perfusion defects as adenosine: a quantitative analysis from the ADVANCE MPI 2 trial. JACC Cardiovasc Imaging 2:959–968

    Article  PubMed  Google Scholar 

  50. Bouvier F, Hojer J, Hulting J, Ruiz H, Samad B, Jensen-Urstad M (1998) Myocardial perfusion scintigraphy (SPECT) during adenosine stress can be performed safely early on after thrombolytic therapy in acute myocardial infarction. Clin Physiol 18:97–101

    Article  PubMed  CAS  Google Scholar 

  51. Heller GV, Brown KA, Landin RJ, Haber SB (1997) Safety of early intravenous dipyridamole technetium 99 m sestamibi SPECT myocardial perfusion imaging after uncomplicated first myocardial infarction. Early Post MI IV Dipyridamole Study (EPIDS). Am Heart J 134:105–111

    Article  PubMed  CAS  Google Scholar 

  52. Geleijnse ML, Elhendy A, Fioretti PM, Roelandt JR (2000) Dobutamine stress myocardial perfusion imaging. J Am Coll Cardiol 36:2017–2027

    Article  PubMed  CAS  Google Scholar 

  53. Attenhofer CH, Pellikka PA, McCully RB, Roger VL, Seward JB (1997) Paradoxical sinus deceleration during dobutamine stress echocardiography: description and angiographic correlation. J Am Coll Cardiol 29:994–999

    Article  PubMed  CAS  Google Scholar 

  54. Jagathesan R, Kaufmann PA, Rosen SD et al (2005) Assessment of the long-term reproducibility of baseline and dobutamine-induced myocardial blood flow in patients with stable coronary artery disease. J Nucl Med 46:212–219

    PubMed  Google Scholar 

  55. Aydin M, Caner B, Yildirir A, Sari O, Tokgozoglu L (2000) Dobutamine combined with low-level exercise for myocardial perfusion scintigraphy. Nucl Med Commun 21:1015–1020

    Article  PubMed  CAS  Google Scholar 

  56. Pennell DJ, Underwood SR, Ell PJ (1993) Safety of dobutamine stress for thallium-201 myocardial perfusion tomography in patients with asthma. Am J Cardiol 71:1346–1350

    Article  PubMed  CAS  Google Scholar 

  57. Reyes E, Rahman S, Loong CY, Anagnostopoulos C, Underwood SR. Comparison of nurse and doctor supervised stress testing in the setting of radionuclide myocardial perfusion imaging (abstract). Nucl Med Commun 2002; 23:380

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nuclear Medicine Department, Royal Brompton Hospital, London, UK

    Eliana Reyes

Authors
  1. Eliana Reyes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eliana Reyes .

Editor information

Editors and Affiliations

  1. Fondazione Toscana Gabriele Monasterio, Department of Nuclear Medicine, CNR Institute of Clinical Physiology, Pisa, Italy

    Paolo Marzullo

  2. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Giuliano Mariani

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Italia

About this chapter

Cite this chapter

Reyes, E. (2013). How Should We Stress the Human Heart?. In: Marzullo, P., Mariani, G. (eds) From Basic Cardiac Imaging to Image Fusion. Springer, Milano. https://doi.org/10.1007/978-88-470-2760-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2760-2_2

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2759-6

  • Online ISBN: 978-88-470-2760-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation