Pharmacologic stress myocardial perfusion imaging: A practical approach

Miyamoto, Michael I.; Vernotico, Sharon L.; Majmundar, Haresh; Thomas, Gregory S.

doi:10.1016/j.nuclcard.2007.01.006

Cited by 30 publications

(14 citation statements)

References 32 publications

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“…Pharmacologic stress can be done with vasodilator agents (adenosine, dipyridamole, adenosine triphosphate, or selective adenosine A2a receptor agonist) or with inotropic and chronotropic agents (dobutamine or arbutamine). Patients with left bundle branch block (LBBB) or electronically paced rhythms may have anteroseptal perfusion defects with exercise or dobutamine perfusion imaging unrelated to stenosis of the left anterior descending artery and hence vasodilator stress testing is recommended in these patients (6,7,8,9). Adenosine and dipyridamole stress have been used in combination with exercise especially in patients with limited exercise capacity.…”

Section: Coronary Artery Disease -Exercise and Pharmacologic Stress Testmentioning

confidence: 99%

Myocardial Perfusion Imaging in Diagnosis of Culprit Lesion in Patients Undergoing Elective Percutaneous Coronary Intervention

Baskot¹,

Obradovic²,

Rafajlovski³

et al. 2011

Coronary Angiography - Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease

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Section: Coronary Artery Disease -Exercise and Pharmacologic Stress Testmentioning

confidence: 99%

Myocardial Perfusion Imaging in Diagnosis of Culprit Lesion in Patients Undergoing Elective Percutaneous Coronary Intervention

Baskot¹,

Obradovic²,

Rafajlovski³

et al. 2011

Coronary Angiography - Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease

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“…The use of dipyridamole-containing medications and the adenosine receptor antagonists aminophylline, theophylline, and caffeine are heavily restricted before the procedure (7). 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).…”

Section: Pharmacologic Stress Agentsmentioning

confidence: 99%

“…Approximately 8.5 million stress MPI studies are performed yearly in the United States, of which around 40% use vasodilator pharmacologic stress agents (8). Furthermore, the use of pharmacologic stress agents or a combination of pharmacologic stress and low-level exercise is increasing (9,10). In the future, the number of stress MPI studies is expected to rise as the population ages and the prevalence of cardiovascular risk factors, such as obesity and diabetes, increases.…”

mentioning

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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“…Motion correction software 2 Attenuation correction 3,4 Perform a second image in selected patients Image prone to allow another view of the inferior wall or the opportunity to see an anterior wall defect shift position as the breast shifts position 5 Delayed imaging-if the gut overlaps the left ventricle on the initial scan wait for it to clear and repeat the image 6 …”

Section: Imaging Techniquesmentioning

confidence: 99%

“…Achieve an adequate heart rate or change to pharmacologic stress 6,7 Add low level exercise to pharmacologic stress 8,9 Clinical information:…”

Section: Protocolsmentioning

confidence: 99%