Abstract
Background
The objectives of this study were 2-fold: (1) to determine the tolerance of adenosine perfusion tomography with the use of an abbreviated (3-minute) infusion in comparison to the standard (6-minute) infusion, and (2) to assess the relative diagnostic accuracy of a 3-minute adenosine infusion in patients referred for arteriography. An abbreviated adenosine infusion may decrease the frequency and duration of side effects and be a more cost-effective alternative.
Methods and Results
We prospectively randomized 599 patients undergoing adenosine myocardial perfusion tomography to either a 3-minute or 6-minute adenosine infusion at 140 μg/kg per minute. Among the 599 enrolled patients, 142 subsequently underwent coronary angiography. Patients randomized to the 3-minute adenosine infusion tolerated the procedure better than those randomized to the standard infusion (P < .01). Flushing, headache, neck pain, and atrioventricular block were all significantly less frequent (P < .01) with the abbreviated infusion. Moreover, patients receiving the abbreviated infusion had less hypotension and tachycardia (P < .05). The sensitivity of the test for detection of coronary artery disease was 88% for both the 3- and 6-minute infusions. In patients with abnormal scan results, perfusion defect size was slightly larger in those receiving a 6-minute infusion versus those receiving a 3-minute infusion (P = .05).
Conclusions
An abbreviated 3-minute adenosine infusion, in combination with perfusion tomography, has similar sensitivity for detection of coronary artery disease and is better tolerated than the standard 6-minute infusion.
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References
Mahmarian JJ, Pratt CM, Nishimura S, Abreu A, Verani MS. Quantitative adenosine Tl-201 single-photon emission computed tomography for the early assessment of patients surviving acute myocardial infarction. Circulation 1993; 87: 1197–210.
Abreu A, Mahmarian JJ, Nishimura S, Boyce TM, Verani MS. Tolerance and safety of pharmacologic coronary vasodilation with adenosine in association with thallium-201 scintigraphy in patients with suspected coronary artery disease. J Am Coll Cardiol 1991; 18: 730–5.
Lagerqvist B, Sylven C, Waldenstrom A. Lower threshold for adeno-sine-induced chest pain in patients with angina and normal coronary angiograms. Br Heart J 1992; 68: 282–5.
Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian A. Safety profile of adenosine stress perfusion imaging: results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol 1994; 23: 384–9.
O’Keefe JH Jr, Bateman TM, Silvestri R, Barnhart C. Safety and diagnostic accuracy of adenosine thallium-201 scintigraphy in patients unable to exercise and those with left bundle branch block. Am Heart J 1992; 124: 614–21.
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.
Shryock JC, Belardinelli L. Adenosine and adenosine receptors in the cardiovascular system: biochemistry, physiology, and pharmacology. Am J Cardiol 1997; 79: 2–10.
Fredholm BB, Abbracchio MP, Burnstock G, Daly JW, Harden TK, Jacobson KA, et al. Nomenclature and classification of purinoreceptors. Pharmacol Rev 1994; 46: 143–56.
Olah ME, Stiles GL. Adenosine receptor subtypes: characterization and therapeutic regulation. Ann Rev Pharmacol Toxicol 1995; 35: 581–606.
Wilson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD. Effects of adenosine on human coronary arterial circulation. Circulation 1990; 82: 1595–606.
Rossen JD, Quillen JE, Lopez AG, Stenberg RG, Talman CL, Winniford MD. Comparison of coronary vasodilation with intravenous dipyridamole and adenosine. J Am Coll Cardiol 1991; 18: 485–91.
Villegas BJ, Hendel RC, Dahlberg ST, McSherry BA, Leppo JA. Comparison of 3- versus 6-minute infusions of adenosine in thallium-201 myocardial perfusion imaging. Am Heart J 1993; 126: 103–7.
O’Keefe JH Jr, Bateman TM, Handlin LR, Barnhart CS. Four- versus 6-minute infusion protocol for adenosine thallium-201 single photon emission computed tomography imaging. Am Heart J 1995; 129: 482–7.
Cabell F, Weiss DS, Price JM. Inhibition of adenosine-induced coronary vasodilation by block of large-conductance Ca(2+)-activated K+ channels. Am J Physiol 1994; 267: H1455–60.
Kleppisch T, Nelson MT. Adenosine activates ATP-sensitive potassium channels in arterial myocytes via A2 receptors and cAMP-dependent protein kinase. Proc Natl Acad Sci U S A 1995; 92: 12441–5.
Shryock JC, Snowdy S, Baraldi PG, Cacciari B, Spalluto G, Monopoli A, et al. A2A-adenosine receptor reserve for coronary vasodilation. Circulation 1998; 98: 711–8.
Belardinelli L, Shryoock JC, Song Y, Wang D, Srinivas M. Ionic basis of the electrophysiological actions of adenosine on cardiomyocytes. FASEB J 1995; 9: 359–65.
Van Calker D, Mueller M, Hambrecht B. Adenosine regulates via two different types of receptors, the accumulation of cyclic AMP in cultured brain cells. J Neurochem 1979; 33: 999–1005.
Salvatore CA, Jacobson MA, Taylor HE, Linden J, Johnson RG. Molecular cloning and characterization of the human A3 adenosine receptor. Proc Natl Acad Sci U S A 1993; 90: 10365–9.
Nishimura S, Mahmarian JJ, Boyce TM, Verani MS. Quantitative thallium-201 single-photon emission computed tomography during maximal pharmacologic coronary vasodilation with adenosine for assessing coronary artery disease. J Am Coll Cardiol 1991; 18: 736–45.
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Treuth, M.G., Reyes, G.A., He, ZX. et al. Tolerance and diagnostic accuracy of an abbreviated adenosine infusion for myocardial scintigraphy: A randomized, prospective study. J. Nucl. Cardiol. 8, 548–554 (2001). https://doi.org/10.1067/mnc.2001.116167
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DOI: https://doi.org/10.1067/mnc.2001.116167