Abstract
In the assessment and evaluation of patients with suspected coronary artery disease there is a need for pharmacological stress combined with thallium scintigraphy. Thallium images were obtained following stress both with dobutamine infusion (5–20 μg kg−1 min−1) and with symptom-limited bicycle ergometry in 20 patients (age 39–70 years) with chest pain who had been admitted for coronary angiography. Percentage thallium uptake was calculated using a region of interest technique. Detailed comparison was performed of the presence, size and distribution of left ventricular thallium perfusion defects; the percentage thallium uptake in ventricles, lung and liver; and the haemodynamic response to stress. Each stress produced a similar number of abnormal segments in each of three views (total EX 166/300; DOB 167/295), but exercise produced larger defects in the anterior view (P<0.025). Thallium uptake in left and right ventricles and relative uptake to lungs were similar, but dobutamine produced higher relative liver uptake [EX 1.55 (0.67); DOB 2.97 (1.23) P<0.0001]. Fourteen patients were able to tolerate dobutamine 20 μg kg−1 min−1. The ratio of peak stress to rest double product was smaller with dobutamine in both patients with (DOB 1.3; EX 2.0; P<0.0047) and patients without β-blockade (DOB 1.5; EX 2.4; P<0.008). Dobutamine produced fewer conventional stress endpoints of chest pain and ST depression. In conclusion, dobutamine produces a well-tolerated incremental pharmacological stress with thallium images similar to maximal exercise, and provides a useful alternative stress in patients unable to perform adequate dynamic exercise.
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Correspondence to: D.R. Wallbridge
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Wallbridge, D.R., Tweddel, A.C., Martin, W. et al. A comparison of dobutamine and maximal exercise as stress for thallium scintigraphy. Eur J Nucl Med 20, 319–323 (1993). https://doi.org/10.1007/BF00169807
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DOI: https://doi.org/10.1007/BF00169807