scholarly journals Adenosine stress protocols for myocardial perfusion imaging

2008 ◽  
Vol 65 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Branislav Baskot ◽  
Slobodan Obradovic ◽  
Branko Gligic ◽  
Vjekoslav Orozovic ◽  
Andjelka Ristic-Angelkov ◽  
...  
Keyword(s):  
Side Effects ◽  
Myocardial Perfusion ◽  
Stress Test ◽  
Onset Time ◽  
Treadmill Test ◽  
Pharmacological Stress ◽  
Pharmacological Agents ◽  
Low Level ◽  
Beneficial Impact ◽  
Artery Disease

Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. There are many patients, however, who may not be able to undergo treadmill test. Such patients would benefit from pharmacological stress procedures combined with MPS. The most commonly used pharmacological agents for cardiac stress are coronary vasodilatators (adenosine, dipyridamol) and catecholamines. Concomitant low-level treadmill exercise with adenosine pharmacologic stress (AdenoEX) during MPS has become commonly used in recent years. A number of studies have demonstrated a beneficial impact of AdenoEX protocol. The aim of the study was, besides introducing into practice the two types of protocols of pharmatological stress test with adenosine, as a preparation for MPS, to compare and monitor the frequency of their side effects to quality, acquisition, as well as to standardize the onset time of acquisition (diagnostic imaging) for both protocols. Methods. A total of 130 patients underwent pharmacological stress test with adenosine (vasodilatator). In 108 of the patients we performed concomitant exercise (AdenoEX) of low level (50W) by a bicycle ergometar. In 28 of the patients we performed Adenosine abbreviated protocol (AdenoSCAN). Side effects of adenosine were followed and compared between the two kinds of protocols AdenoEX and AdenoSCAN. Also compared were image quality and suggested time of acquisition after the stress test. Results. Numerous side effects were found, but being short-lived they did not require any active interventions. The benefit of AdenoEX versus AdenoSCAN included decreased side effects (62% vs 87%), improved safety and patients tolerance, improved target-to-background ratios because of less subdiaphragmatic activity, earlier acquisition, and improved sensitivity. Conclusion. The safety and efficacy of adenosine pharmacological stress is even better with concomitant exercise. In the light of these benefits we recommend AdenoEX whenever possible.

scholarly journals Study of efficacy and safety of pharmacological stress tests in nuclear cardiology

2009 ◽  
Vol 66 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Branislav Baskot ◽  
Saso Rafajlovski ◽  
Andjelka Ristic-Angelkov ◽  
Slobodan Obradovic ◽  
Branko Gligic ◽  
...  
Keyword(s):  
Side Effects ◽  
Stress Testing ◽  
Stress Test ◽  
Stress Tests ◽  
Pharmacological Stress ◽  
Safety And Efficacy ◽  
Low Level ◽  
Low Intensity ◽  
Pharmacological Stress Test ◽  
Low Intensity Exercise

Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. Many patients who cannot adequately perform exercise stress testing may nevertheless undergo pharmacological tests, most commonly with the vasodilator agents (adenosine and dipyridamole), as well as the positive inotropic agent dobutamine. Patients undergoing vasodilators stress testing with either dipyridamole or adenosine also perform simultaneous low-intensity exercise. The aim of this study was to compare various pharmacological stress tests alone or in combination with low intensity exercise as preparation for MPS in reagard to incidence of adverse effects, quality of diagnostic image and the acquisition initial time. Methods. A total of 2 205 patients underwent pharmacological stress tests. Pharmacological stress test with adenosine was applied in 493 patients. In 405 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (AdenoEX). In 88 of them we performed adenosine abbreviated protocol (AdenoSCAN). In 1 526 patients we performed pharmacological stress test with dipyridamole. In 871 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (DipyEX), and in 775 we used only dipyridamole protocol (DipySCAN). In 186 patients we used pharmacological stress test with dobutamine. We followed side effects of adenosine, dipyiridamole and dobutamine, compared results between protocols with concomitant low level exercise and vasodilatators only. We also compared image quality, and suggested time of acquisition after stress test. Results. We found numerous side effects especially with adenosine, but these effects were short-lived and not required active interventions. Benefit with concomitant exercise in booth AdenoEX and DipyEX included decreased side effects (AdenoEX vs AdenoSCAN 62% vs 87%, respectively, and DipyEX vs DipySCAN 37% vs 59%, respectively) improved safety and patients tolerance, improved target-to-background ratios because of less subdiaphragmal activity, and earlier acquisition time. Because of producing a lot of arrhythmias (in 49% of patients) dobutamin was considered a last choice for pharmacological stress testing. Conclusion. Safety and efficacy of vasodilatators (adenosine, dipyridamole) pharmacological stress tests are good, but with concomitant exercise even better. The safety and efficacy of adenosin are better than those of dipyridamole. AdenoEX protocol provides good safety and patients tolerance. In light of these benefits we recommend AdenoEX whenever possible. Dobutamine is the last pharmacological toll for MPS.

scholarly journals Regadenoson myocardial perfusion scintigraphy for the evaluation of coronary artery disease in patients with lung disease: A series of five cases

2019 ◽  
Vol 27 (1) ◽  
pp. 315-321 ◽  
Author(s):  
Eliana Reyes ◽  
Stephen Richard Underwood
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Case Series ◽  
Pharmacological Stress ◽  
Perfusion Scintigraphy ◽  
Serious Adverse Events ◽  
Artery Disease ◽  
Respiratory Conditions

AbstractCoronary artery disease (CAD) is a leading cause of death and morbidity globally. Myocardial perfusion scintigraphy (MPS) is commonly used for the diagnosis of CAD, necessitating hyperaemia achieved either by physical exertion or by pharmacological stress, most commonly through use of a coronary arteriolar dilator. This is challenging in patients with respiratory conditions because exercise may be submaximal and adenosine is contraindicated because of the risk of bronchoconstriction. Regadenoson is the only selective adenosine A2A receptor agonist approved as a vasodilator in MPS. The risk of bronchospasm with regadenoson has been investigated in large, randomised trials; however, patients with the most severe respiratory conditions were not included. In this case series, we present the use of regadenoson MPS in five patients with moderate-to-severe lung conditions, including patients requiring lung volume reduction surgery and lung transplant. In all cases, regadenoson MPS provided valuable information for risk assessment and treatment optimisation. Although dyspnoea occurred in all patients, regadenoson was well tolerated without serious adverse events or bronchospasm; in no case was intervention required to treat dyspnoea.

Myocardial Perfusion SPECT 2018 in Germany: Results of the 8th Survey

2019 ◽  
Vol 58 (06) ◽  
pp. 425-433 ◽  
Author(s):  
Oliver Lindner ◽  
Wolfgang Burchert ◽  
Ronny Buechel ◽  
Wolfgang Michael Schäfer ◽  
Keyword(s):  
Myocardial Perfusion ◽  
Gated Spect ◽  
Stress Test ◽  
Myocardial Perfusion Spect ◽  
Positive Development ◽  
University Hospitals ◽  
Pharmacological Stress ◽  
Perfusion Spect ◽  
Pharmacological Stress Test ◽  
Current Guidelines

Abstract Aim This paper presents the results of the 8th survey of myocardial perfusion SPECT (MPS) from the reporting year 2018. Methods 291 questionnaires (184 practices (PR), 77 hospitals (HO), 30 university hospitals (UH)) were evaluated. Results of the last survey from 2015 are set in squared brackets. Results MPS of 145 930 [121 939] patients were reported (+ 19.6 %). 76 % [78 %] of all patients were studied in PR, 16 % [14 %] in HO, and 8 % [8 %] in UH, mostly with a 2-day-protocol 48 % [50 %]. 99.96 % [98 %] of all MPS were performed with Tc-99 m radiopharmaceuticals and in 0.04 % with Tl-201.A pharmacological stress test was applied in 49 % [43 %] (23 % [22 %] adenosine, 26 % [20 %] regadenoson, dipyridamole or dobutamine together < 1 % [1 %]). Attenuation correction was performed in 26 % [25 %] of all MPS, gated SPECT in 86 % [80 %] of stress MPS, in 87 % [78 %] of rest and in 83 % [76 %] of all stress and rest MPS. 67 % [53 %] of the departments performed MPS scoring by default, whereas 16 % [24 %] did not apply this feature at all.69 % [60 %] reported an increase or no changes in their MPS patient numbers. One hundred twenty-six departments which participated in the surveys from 2009 to 2018 reported an increase in MPS by 44 %. 69 % [70 %] of the MPS were requested by ambulatory care cardiologists. Conclusion The 2018 MPS survey reveals a high-grade adherence of routine MPS practice to current guidelines. The positive development in MPS performance and MPS numbers observed since 2012 remains ongoing.

Abstract P326: Myocardial Ischemia and Mobilization of Circulating Progenitor Cells

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Muhammad Hammadah ◽  
Ayman Samman Tahhan ◽  
Ibhar Almheid ◽  
Bryan Ross Kindya ◽  
Mazen Ghafeer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Progenitor Cells ◽  
Linear Models ◽  
Stress Test ◽  
Exercise Stress ◽  
Previous Myocardial Infarction ◽  
Pharmacological Stress ◽  
Pharmacological Stress Test

Background: Circulating progenitor cells (CPCs) are involved in vascular repair and regeneration. Low levels of CPCs in patients with CAD have been linked to adverse cardiovascular outcomes. The response of CPCs to transient myocardial ischemia in patients with CAD has not been studied before. We aimed to investigate the CPC response to exercise provoked myocardial ischemia (demand ischemia), and compare it to myocardial ischemia detected during pharmacological stress test (flow mismatch). Methods: 570 patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during exercise (69%), or pharmacological stress (31%). myocardial ischemia was defined as a new or worsening impairment in myocardial perfusion using a 17-segment model. CD34+ CPCs were enumerated by flow cytometry at rest and 30 min after stress testing. The change in CPC count was compared between patients with and without myocardial ischemia using mixed linear models. Results: Mean age was 63±9 years, 76% males, 36% with previous myocardial infarction. The incidence of myocardial ischemia was 31% and 41% during exercise and pharmacological stress test, respectively. No difference was observed in resting CPC between patients undergoing exercise vs pharmacological stress test, nor between patients with or without myocardial ischemia. However, patients who developed myocardial ischemia during exercise stress had a significant decrease in CPC with stress in comparison to those without myocardial ischemia (-12% vs 4%, respectively, p=0.006). Furthermore, the change in CPCs was inversely correlated with the magnitude of myocardial ischemia (R=-0.13, p=0.023), suggesting a greater CPC reduction with larger ischemic burden. These findings remained significant even after adjustment for age, gender, race, BMI, previous myocardial infarction, resting levels of CPCs and hematocrit change with stress. No difference was observed in CPC response to pharmacological stress test (change of -1% vs 3%, for patients with and without myocardial ischemia, respectively, p=0.96). Conclusion: Exercise stress-induced myocardial ischemia is associated with a decrease in CPC counts, likely due to increased homing of stem cells to the ischemic myocardium. Whether the extent of CPC uptake has prognostic implication, or whether the CPC response can be altered with intervention needs further investigation.

scholarly journals Myocardial perfusion SPECT 2015 in Germany

2017 ◽  
Vol 56 (01) ◽  
pp. 31-38 ◽  
Author(s):  
Wolfgang Burchert ◽  
Wolfgang Schäfer ◽  
Marcus Hacker ◽  
Oliver Lindner
Keyword(s):  
Nuclear Medicine ◽  
Myocardial Perfusion ◽  
Stress Test ◽  
Myocardial Perfusion Spect ◽  
German Society ◽  
Positive Trend ◽  
University Hospitals ◽  
Educational Training ◽  
Pharmacological Stress ◽  
Perfusion Spect

SummaryAim: The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine presents the results of the 7th survey of myocardial perfusion SPECT (MPS) of the reporting year 2015. Method: 268 guestionnaires (173 practices [PR], 67 hospitals [HO], 28 university hospitals ]UH[) were evaluated. Results of the last survey from 2012 are set in sguared brackets. Results: MPS of 121939 [105941] patients were reported. 98% [95 %] of all MPS were performed with Tc-99m radiopharmaceuticals and 2 % [5 %] with TI-201.78% [79%] of all patients were studied in PR, 14% [15%] in HO, and 8% [6%] in UH. A pharmacological stress test was performed in 43% [39%] (22 % [24 %] adenosine, 20 % [9 %] regade- noson, 1 % [6 %] dipyridamole or dobutamine). Attenuation correction was applied in 25 % [2009: 10 %] of MPS. Gated SPECT was performed in 78 % [70 %] of all rest MPS, in 80 % [73 %] of all stress and in 76 % [67 %] of all stress and rest MPS. 53 % [33 %] of all nuclear medicine departments performed MPS scoring by default, whereas 24% [41 %] did not apply any quantification. 31 % [26 %] of all departments noticed an increase in their counted MPS and 29% [29%] no changes. Data from 89 departments which participated in all surveys showed an increase in MPS count of 11.1 % (PR: 12.2 %, HO: 4.8%, UH: 18.4%). 70 % [60 %] of the MPS were reguested by ambulatory care cardiologists. Conclusion: The 2015 MPS survey reveals a high-grade adherence of routine MPS practice to current guidelines. The positive trend in MPS performance and number of MPS already observed in 2012 continues. Educational training remains necessary in the field of SPECT scoring.

scholarly journals The effect of acute exercise on interleukin-6 and hypothalamic–pituitary–adrenal axis responses in patients with coronary artery disease

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Zeid Mahmood ◽  
Anette Davidsson ◽  
Eva Olsson ◽  
Per Leanderson ◽  
Anna K. Lundberg ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Physical Exercise ◽  
Hpa Axis ◽  
Acute Exercise ◽  
Stress Test ◽  
Exercise Stress ◽  
Artery Disease ◽  
Acute Physical Exercise

AbstractVulnerability to stress-induced inflammation has been linked to a dysfunctional hypothalamus–pituitary–adrenal (HPA) axis. In the present study, patients with known or suspected coronary artery disease (CAD) were assessed with respect to inflammatory and HPA axis response to acute physical exercise. An exercise stress test was combined with SPECT myocardial perfusion imaging. Plasma and saliva samples were collected before and 30 min after exercise. Interleukin (IL)-6 and adrenocorticotropic hormone (ACTH) were measured in plasma, while cortisol was measured in both plasma and saliva. In total, 124 patients were included of whom 29% had a prior history of CAD and/or a myocardial perfusion deficit. The levels of exercise intensity and duration were comparable in CAD and non-CAD patients. However, in CAD patients, IL-6 increased after exercise (p = 0.019) while no differences were seen in HPA axis variables. Conversely, patients without CAD exhibited increased levels of ACTH (p = 0.003) and cortisol (p = 0.004 in plasma, p = 0.006 in saliva), but no change in IL-6. We conclude that the IL-6 response to acute physical exercise is exaggerated in CAD patients and may be out of balance due to HPA axis hypoactivity. It remains to be further investigated whether this imbalance is a potential diagnostic and therapeutic target in CAD.

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