Comparison of maximal myocardial blood flow during adenosine infusion with that of intravenous dipyridamole in normal men

Chan, Sammy; Brunken, Richard C.; Czernin, Johannes; Porenta, Gerold; Kuhle, William; Krivokapich, Janine; Phelps, Michael E.; Schelbert, Heinrich R.

doi:10.1016/0735-1097(92)90201-w

Cited by 159 publications

(52 citation statements)

References 13 publications

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“…However, the coronary perfusions measured in each myocardial wall at baseline after treatment were not considered to be increased enough compared with previous studies. [11][12][13][14][15] Nor was the recovery of CFR in the septal and inferior walls on dipyridamole provocation after EECP treatment enough compared with previous studies. 9,[11][12][13][14][15] We hypothesized that the decrease in the CFR at anterior and lateral walls was because the coronary perfusion at baseline after treatment increased compared with that done before treatment, and the blood steal from the anterior and lateral walls to the inferior wall might have been augmented with the developed collateral vessels.…”

Section: Discussionmentioning

confidence: 99%

Improvement of Regional Myocardial and Coronary Blood Flow Reserve in a Patient Treated With Enhanced External Counterpulsation

et al. 1999

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Section: Discussionmentioning

confidence: 99%

Improvement of Regional Myocardial and Coronary Blood Flow Reserve in a Patient Treated With Enhanced External Counterpulsation

et al. 1999

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“…Prior data have shown equivalence in the hyperemia achieved with these agents and more importantly, no agent-specific effect on the association between global CFR and patient outcomes. 11,22 To ensure stability of intravascular volume and serum electrolytes, it is standard practice in our nuclear cardiology laboratory not to administer intravenous vasodilator stress agents on the day of dialysis. CFR measurements are obtained through postprocessing of PET images and therefore, do not involve additional radiation exposure, imaging time, or cost to the patient.…”

Section: Pet Imagingmentioning

confidence: 99%

Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

Shah

Charytan²,

Murthy

et al. 2015

JASN

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Capillary rarefaction of the coronary microcirculation is a consistent phenotype in patients with dialysisdependent ESRD (dd-ESRD) and may help explain their excess mortality. Global coronary flow reserve (CFR) assessed by positron emission tomography (PET) is a noninvasive, quantitative marker of myocardial perfusion and ischemia that integrates the hemodynamic effects of epicardial stenosis, diffuse atherosclerosis, and microvascular dysfunction. We tested whether global CFR provides risk stratification in patients with dd-ESRD. Consecutive patients with dd-ESRD clinically referred for myocardial perfusion PET imaging were retrospectively included, excluding patients with prior renal transplantation. Perpatient CFR was calculated as the ratio of stress to rest absolute myocardial blood flow. Multivariable Cox proportional hazards models, including age, overt cardiovascular disease, and myocardial scar/ischemia burden, were used to assess the independent association of global CFR with all-cause and cardiovascular mortality. The incremental value of global CFR was assessed with relative integrated discrimination index and net reclassification improvement. In 168 patients included, median global CFR was 1.4 (interquartile range, 1.2-1.8). During follow-up (median of 3 years), 36 patients died, including 21 cardiovascular deaths. Log-transformed global CFR independently associated with all-cause mortality (hazard ratio, 0.01 per 0.5-unit increase; 95% confidence interval, ,0.01 to 0.14; P,0.001) and cardiovascular mortality (hazard ratio, 0.01 per 0.5-unit increase; 95% confidence interval, ,0.01 to 0.15; P=0.002). For all-cause mortality, addition of global CFR resulted in risk reclassification in 27% of patients. Thus, global CFR may provide independent and incremental risk stratification for all-cause and cardiovascular mortality in patients with dd-ESRD.

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“…The dose of adenosine or dipyridamole is adjusted according to patient weight and administered by infusion over several minutes, with vital signs and side effects monitored during the infusion (7,9). Both agents cause a 4-to 4.5-fold increase in coronary blood flow (19), which is higher than ideal because of the nonlinear uptake of the radionuclides at higher myocardial flow rates (20). The half-life of adenosine is extremely short (,10 s), whereas the half-life of dipyridamole is approximately 30-45 min (7).…”

Section: Pharmacologic Stress Agentsmentioning

confidence: 99%

Advances in Pharmacologic Stress Agents: Focus on Regadenoson

Johnson¹,

Peters²

2010

Journal of Nuclear Medicine Technology

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Myocardial perfusion imaging using radionuclides is a wellestablished protocol for determining the diagnosis, prognosis, and management of coronary artery disease. Pharmacologic stress agents are used to induce cardiac hyperemia in patients unable to achieve the target workload by physical exercise alone. The vasodilators adenosine and dipyridamole are most commonly used, with dobutamine used only when these agents are contraindicated. However, because of frequent and intense side effects, as well as complex procedures both for patients and the nuclear medicine staff, there is room for improvement in these traditional stress agents. An ideal stress agent would be effective, safe, and well tolerated; have a simple protocol; be suitable for use in patients with reactive airway disease; and have few restrictions for the patient to adhere to before the procedure. Neither adenosine nor dipyridamole are receptorspecific, and act on A 1 , A 2A , A 2B , and A 3 adenosine receptors. As it is the A 2A receptor that mediates the desired coronary vasodilation, the A 1 , A 2B , and A 3 adenosine receptors are deemed responsible for most side effects associated with adenosine and dipyridamole. A 2A -selective pharmacologic stress agents should mediate the required hyperemic response while reducing the frequency of adverse events. The only selective A 2A adenosine receptor agonist currently approved for clinical use as a pharmacologic stress agent for myocardial perfusion imaging is regadenoson. Regadenoson has demonstrated non-inferiority to adenosine for detecting reversible myocardial perfusion defects in phase 3 trials, and patients were more comfortable during the regadenoson stress procedure than during an adenosine infusion. As regadenoson dosing is not dependent on patient weight or renal impairment and can be administered by rapid injection, it has the potential to simplify the stress procedure, reduce costs, and streamline the working day for the staff of the nuclear medicine department. In this review, the need to improve on older pharmacologic stress agents will be considered, along with an assessment of how A 2A receptor agonists fulfill that potential. Practical aspects of regadenoson are reviewed, and the impact that A 2A receptor agonist use may have on the nuclear medicine department is evaluated.

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Comparison of maximal myocardial blood flow during adenosine infusion with that of intravenous dipyridamole in normal men

Abstract: Despite these inter- and intraindividual differences, we conclude that both agents are equally effective in producing myocardial hyperemia.

Cited by 159 publications

References 13 publications

Improvement of Regional Myocardial and Coronary Blood Flow Reserve in a Patient Treated With Enhanced External Counterpulsation

Improvement of Regional Myocardial and Coronary Blood Flow Reserve in a Patient Treated With Enhanced External Counterpulsation

Prognostic Value of Coronary Flow Reserve in Patients with Dialysis-Dependent ESRD

Advances in Pharmacologic Stress Agents: Focus on Regadenoson

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