Skip to main content
SpringerLink
Log in

Adenosine echocardiography — an alternative to dynamic stress echocardiography

  • Articles
  • Published:
The International Journal of Cardiac Imaging Aims and scope Submit manuscript

Abstract

Dynamic exercise echocardiography is sensitive and specific in detection and evaluation of coronary artery disease. Frequently, however, patients cannot achieve maximum exercise because of various factors. The aims of this study were to compare usefulness of adenosine infusion and dynamic exercise to induce myocardial ischemia detected with 2-D echocardiography and standard electrocardiography; to determine the sensitivity of the adenosine echo test; and to evaluate the safety and tolerability of adenosine infusion.

In 31 men with clinical diagnosis of stable angina pectoris, myocardial ischemia was induced by: a) symptom-limited exercise test on a bicycle, and b) intravenous adenosine infusion. The two tests were performed with an average interval of 24 hours. Coronary angiography was performed in 29 of 31 patients and significant coronary artery disease (diameter narrowing >50%) was documented in 26 of these (12 single, 6 two- and 8 three-vessel disease). The criterion for echo positivity was a transient impairment of contraction as compared to the baseline examination in any of 10 segments, with an increase of left ventricular score index of 0.3 or more. ECG positivity was considered as ST60 segment depression of 0.1 mV or more from the reference level in any lead.

Adenosine echo test was positive in 22 out of 26 patients and exercise echo in 19 (sensitivity 85% and 73%, respectively, p=NS). Adenosine ECG test was positive in 14 of 26 patients and exercise ECG test in 21 (sensitivity 54% and 81% respectively, p= NS). In three patients with normal coronary arteriography adenosine echo was negative in all three, exercise echo, adenosine ECG and exercise ECG in two. Side effects due to adenosine infusion were always minor, well tolerated by the patients and disappeared within seconds after termination of infusion. The present study suggests that adenosine test is at least as useful as exercise echo test in the provocation of myocardial ischemia in patients with coronary artery disease and stable angina pectoris.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Iliceto S, Rizzon P. Stress echocardiography ready for routine clinical use? Eur Heart J 1991; 12: 262–5.

    PubMed  Google Scholar 

  2. Guyer DE, Foale RA, Gillam LD, Wilkins GT, Guerrero JL, Weyman AE. An echocardiographic technique for quantifying and displaying the extent of regional left ventricular dyssynergy. J Am Coll Cardiol 1986; 8: 830–5.

    PubMed  Google Scholar 

  3. Oberman A, Fan P-H, Nanda N, Lee JY, Huster W, Sulentic JA, Storey OF. Reproducibility of two-dimensional exercise echocardiography. J Am Coll Cardiol 1989; 14: 923–8.

    PubMed  Google Scholar 

  4. Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A. Stress echocardiography and the human factor: the importance of being expert. J Am Coll Cardiol 1991; 17: 666–9.

    PubMed  Google Scholar 

  5. Picano E. Dipyridamole-echocardiography test: historical background and physiologic basis. Eur Heart J 1989; 10: 365–76.

    PubMed  Google Scholar 

  6. Gould KL, Westcott RJ, Albro PC, Hamilton GW. Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilatation. Am J Cardiol 1978; 41: 279–87.

    PubMed  Google Scholar 

  7. Picano E, Severi S, Michelassi C, Lattanzi F, Masini M, Orsini E, Distante A, L'Abbate A. Prognostic importance of dipyridamole-echocardiography test in coronary artery disease. Circulation 1989; 80: 450–7.

    PubMed  Google Scholar 

  8. Picano E, Simonette I, Masini M, Marzilli M, Lattanzi F, Distante A, De Nes M, L'Abbate A. Transient myocardial dysfunction during pharmacologic vasodilation as an index of reduced coronary reserve: a coronary hemodynamic and echocardiographic study. J Am Coll Cardiol 1986; 8: 84–90.

    PubMed  Google Scholar 

  9. Picano E, Lattanzi F, Masini M, Distante A, L'Abbate A. High dose dipyridamole echocardiography test in effort angina pectoris. J Am Coll Cardiol 1986; 8: 848–54.

    PubMed  Google Scholar 

  10. Buchalter MB, Bourke JP, Heads A, Hawkins T. Dipyridamole echocardiography: the bedside stress test for coronary artery disease. Postgrad Med J 1990; 66: 531–5.

    PubMed  Google Scholar 

  11. Iskandrian AS, Heo J, Askenase A, Segal BL, Auerbach N. Dipyridamole cardiac imaging. Am Heart J 1987; 115: 432–43.

    Google Scholar 

  12. Klabunde RE. Dipyridamole inhibition of adenosine metabolism in human blood. Eur J Pharm 1983; 93: 21–6.

    Google Scholar 

  13. Conradson T-BG, Dixon CMS, Clarke B, Barnes PJ. Cardiovascular effects of infused adenosine in man: potentiation by dipyridamole. Acta Physiol Scand 1987; 129: 387–91.

    PubMed  Google Scholar 

  14. Berne RM. The role of adenosine in the regulation of coronary blood flow. Circulation Research 1980; 47: 807–13.

    PubMed  Google Scholar 

  15. Milliken GA, Johnson DE. Fisher's LSD Procedure. In: ‘Analysis of messy data’. Liftime Learning Publications, Belmont, California, 1984; 1: 31–3.

    Google Scholar 

  16. Colton T. Fisher's exact test. In: ‘Statistics in medicine’. Little, Brown and Company, Boston, Massachusetts, 1982: 164–5.

    Google Scholar 

  17. Becker LC. Conditions for vasodilator-induced coronary steal in experimental myocardial ischemia. Circulation 1978; 57: 1103–10.

    PubMed  Google Scholar 

  18. Cates CU, Kronenberg MW, Collins HW, Sandier MR Dipyridamole radionuclide ventriculography: a test with high specificity for severe coronary artery disease. J Am Coll Cardiol 1989; 13: 841–51.

    PubMed  Google Scholar 

  19. Verani MS, Mahmarian JJ, Hixson JB, Boyce TM, Staudacher RA. Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise. Circulation 1990; 82: 80–7.

    PubMed  Google Scholar 

  20. Verani MS. Adenosine thallium 201 myocardial perfusion scintigraphy. Am Heart J 1991; 122: 269–78.

    PubMed  Google Scholar 

  21. Coyne EP, Belvedere DA, Vande Streek PR, Weiland FL, Evans RB, Spaccavento LJ. Thallium-201 scintography after intravenous infusion of adenosine compared with exercise thallium testing in the diagnosis of coronary artery disease. J Am Coll Cardiol 1991; 17: 1289–94.

    PubMed  Google Scholar 

  22. Iskandrian AS. Single-photon emission computed tomographic thallium imaging with adenosine, dipyridamole, and exercise. Am Heart J 1991; 122: 279–84.

    PubMed  Google Scholar 

  23. Wackers FJ. Adenosine or dipyridamole: which is preferred for myocardial perfusion imaging? J Am Coll Cardiol 1991; 17: 1295–6.

    PubMed  Google Scholar 

  24. Zoghbi WA. Use of adenosine echocardiography for diagnosis of coronary artery disease. Am Heart J 1991; 122: 285–92.

    PubMed  Google Scholar 

  25. Strååt E, Henriksson P, Edlund A. Adenosine provokes myocardial ischemia in patients with ischemic heart disease without increasing cardiac work. J Int Med 1991; 230: 319–23.

    Google Scholar 

  26. Edlund A, Albertsson P, Caidahl K, Emanuelsson H, Wallentin I. Adenosine infusion to patients with ischemic heart disease may provoke dysfunction detected by echocardiography. Clin Physiol 1991; 11: 477–88.

    PubMed  Google Scholar 

  27. Trakhtenbroit AD, Cheirif J, Kleiman N, Verani MS, Zoghbi WA. Adenosine echocardiography in diagnosis of coronary artery disease: comparison with coronary angiography. Circulation (suppl. III) 1990; 82: 0763.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Sahlgrenska Hospital, S-413 45, Göteborg, Sweden

    Vuk G. Kujacic, Dalia Jablonskiene & Håkan U. Emanuelsson

Authors
  1. Vuk G. Kujacic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dalia Jablonskiene
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Håkan U. Emanuelsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kujacic, V.G., Jablonskiene, D. & Emanuelsson, H.U. Adenosine echocardiography — an alternative to dynamic stress echocardiography. Int J Cardiac Imag 9, 169–177 (1993). https://doi.org/10.1007/BF01145318

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01145318

Key words

Search

Navigation