Title | Pharmacological stress test in radionuclide studies | |
Authors | Sophie I. Mavrogeni, Dudley J. Pennell and Richard S. Underwood
Nuclear Medicine Department, Royal Brompton National Heart and Lung Hospitals, London, U.K. |
|
Citation | Mavrogeni, S.I., Pennell, D.J., Underwood, R.S.: Pharmacological stress test in radionuclide studies, Epitheorese Klin. Farmakol. Farmakokinet. 6(3): 124-129 (1992) | |
Publication Date | Received for publication: 11 November 1992
Accepted for publication: 15 November 1992 |
|
Full Text Language | English | |
Order – Buy | Ηλεκτρονική Μορφή: pdf (10 €) – Digital Type: pdf (10 €)
pharmakonpress[at]pharmakonpress[.]gr |
|
Keywords | Radionuclide studies, dipyridamole, adenosine, dobutamine. | |
Other Terms | review article | |
Summary | Although dynamic exercise is the best technique for stressing patients during myocardial perfusion imaging, it is not always applicable because of physical or psychological disabilities of patients. In this case pharmacological stress test can replace dynamic exercise. The most commonly used drugs are: dipyridamole, adenosine and dobutamine. Dipyridamole is given intravenously by a 4 min infusion of 0.56 mg/kg. It acts as arteriolar dilator through an increase of interstitial adenosine. Its adverse side effects are headache, flushing, hypotension. It is proven that it has good safety and its results are comparable with dynamic exercise. Caffeine, colas, tea and cocoa should not be taken in the 12h before the infusion, because they antagonize the action of adenosine. Adenosine is given as an intravenous infusion of 140 μg/kg/min for 6 min. Its main advantage is the very short plasma half- life of less than 10 sec, which simplifies the control of plasma levels. Adverse effects of adenosine are headache, flushing and AV block. Both dipyridamole and adenosine should not be given to patients with a history of bronchospasm. Aminophylline can reverse the adverse side effects of both of them. In contrary to previous mentioned drugs, dobutamine, a beta-agonist, acts by increasing the myocardial oxygen demand through an increase in heart rate and blood pressure. Its action is antagonised by beta-blockers, which must be discontinued 48h before the study. It is infused in a peripheral vein starting at 5 μg/kg/min and increasing in increments of 5 μg/kg/min to a maximum of 40 μg/kg/min. During the infusion occasional ventricular premature beats may occur: It is unsuitable for patients with contraindications to dynamic exercise, such as aortic stenosis and unstable angina. | |
References | 1. Gould, K.L., Lipscomb, Κ.: Effects of coronary stenoses on coronary flow reserve and resistance. Am. J. Cardiol. 34: 48-55(1974)
2. Szegi, J., Szentmiklosi, A.J., Cseppento, A.: On the action of specific drugs influencing the adnosine induced activation of cardiac purinoreceptors. In: Cardiovascular Pharmacology: Results, Concepts and Perspective (J.G. Papp, ed.), pp. 591 -599, Akademiai Kiado, Budapest, 1987 3. Beller, G.A., Holzgrefe, H.H., Watson, D.D.: Effects of dipyridamole induced vasocilatation on myocardial uptake and clearance kinetics of thallium-201. Circulation 68: 1328-1338 (1983) 4. Flameng, W., Wusten, B„ Schaper, W.: On the distribution of myocardial blood flow. Effects of arterial stenosis and vasodilatation. Basic. Res. Cardiol. 69: 435-446(1974) 5. Gould, K.L.: Noninvasive assessment of coronary stenosis by myocardial perfusion imaging during pharmacologic coronary vasodilatation: Physiologic basis and experimental validation. Am. J. Cardiol. 41: 267-278 (1978) 6. Chambers, C.E., Brown, K.A.: Dipyridamole induced ST segment depression during thallium-201 imaging in patients with coronary artery disease: angiographic and haemodynamic determinants. J. Am. Coll. Cardiol. 12: 37- 41 (1988) 7. Segall, G.M., Davis, M.J.: Variability of serum drug level following a single oral dose of dipyridamole. J. Nucl. Med. 29: 1662-1667 (1988) 8. Wilson, R.F., Laughin, D.E., Ackell, P.H. et al.: Transluminal, subselective measurement of coronary artery blood flow velocity and vasodilator reserve in man. Circulation 72: 82- 92(1985) 9. Harris, D.N.F.: The use of dipyridamole with myocardial imaging. MD Thesis, Bristol University, U.K., 1982 10. Brown, B.G., Josephson, M.A., Petersen, R.B. et al.: Intravenous dipyridamole combined with isometric handgrip for near maximal acute increase in coronary flow in patients with coronary artery disease. Am. J. Cardiol. 48: 1077- 1085(1981) 11. Ranhosky, A., Rawson, J.: The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Circulation 81: 1205-1209 (1990) 12. Varma, S.Κ., Watson, D.D., Beller, G.A.: Quantitative comparison of thallium-201 scintigraphy after exercise and dipyridamole in coronary artery disease. Am. J. Cardiol. 64: 871-877(1989) 13. Homma, S., Gilliland, Y., Guiney, T.E., Strauss, H., Boucher, C.A.: Safety of intravenous dipyridamole for stress testing with thallium imaging. Am. J. Cardiol. 59: 152-154 (1987) 14. Zhu, Y.Y., Chung, W.S., Botvinick, E.H. et al.: Dipyridamole infusion scintigraphy: the experience with its application in one hundred seventy patients with known or suspected unstable angina. Am. Heart J. 121: 33-34 (1991) 15. Pennell, D.J., Underwood, S.R., Ell, P.J.: Symptomatic bradycardia complicating the use of intravenous dipyridamole for thalfium-201 myocardial perfusion imaging. Int. J. Cardiol 27: 272-274 (1990) 16. Casanova, R., Patroncini, A., Guidalotti, P.L., Capacci, P.F., Jacopi, F., Fabbri, M., Maresta, A.: Dose and test for dipyridamole infusion and imaging early after uncomplicated acute myocardial infarction. Am. J. Cardiol. 70: 1402-1406 (1992) 17. Iscandrian, S.A., M.D.: What is the optimum dose of dipyridamole for cardiac imaging? Editorial. Am. J. Cardiol. 70: 1485-1486(1992) 18. Stern, S., Greenberg, D.I., Corne, R.: Effect of exercise sup-plementation on dipyridamole Thallium-201 image quality. J. Nucl. Mad. 32: 1559-1563 (1991) 19. De Puey, E.G., M.D.: Exercise supplementation of dipyridamole for myocardial perfusion imaging. Editorial. J. Nucl. Med. 32: 1564-1568 (1991) 20. Wilson, R.F., Wyche, K., Christensen, B.V., Zimmer, S., Laxson, D.D.: Effects of adenosine on human coronary arterial circulation. Circulation 82: 1595-1606 (1990) 21. Gupta, N.C., Esterbrooks, D.J., Hilleman, D.E., Mohiuddin, S.M.: Comparison of adenosine and exercise Thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. JACC 19: 248-257 (1992) 22. Nguyen, T., Heo, J., Ogilby, D., Iskandrian, A.S.: Single photon emission computed tomography with thallium-201 during adenosine induced coronary hyperaemia: correlation with coronary arteriography, exercise thallium imaging and two dimensional echocardiography. JACC 16: 1375- 1383(1990) 23. Verani, M.S., Mahmarian, J.J., Hixson, J.B., Boyce, T.M., Staudacher, R.A.: Diagnosis of coronary artery disease by controlled coronary vasodilatation with adenosine and thallium-201 scintigraphy in patients unable to exercise. Circulation 82: 80-87 (1990) 24. Sylven, C., Beermann, b., Jonzon, B., Brandt, R.: Angina pectoris like pain provoked by intravenous adenosine In healthy volunteers. Br. Med. J. 293: 227-230 (1986) 25. Faulds, D., Chrisp, P., Buckley, M.M.T.: Adenosine. An evaluation of its use in cardiac diagnostic procedures and in the treatment of paroxysmal supraventricular tachycardia. Drugs 41: 596-624 (1991) 26. Di Marco, J.P., Sellers, T.D., Berne, R.M., West, G.A., Belardinelli, L.: Adenosine: electrophystiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardias. Circulation 68: 1254-1263 (1983) 27. Favale, S., Biase, M.D., Rizzo, U., Belardinelli, L., Rizzon, P.: Effect of adenosine and adenosine-5-triphosphate on atrioventricular conduction in patients. JACC 5: 1212-1219 (1985) 28. Sharma, A.D., Klein, G.J.: Comparative quantitative electrophysiologic effects of adenosine triphosphate on the sinus node and atrioventricular node. Am. J. Cardiol. 61: 330-335 (1988) 29. Clemo, H.F., Belardinelli, L.: Effect of adenosine on a ventricular conduction. 1. Site and characterization of adenosine action in the guinea pig atrioventricular node. Circ. Res. 59: 427-436 (1986) 30. Griffith, M.J., Linker, N.J., Ward, D.E., Canin, A.J.: Adenosine in the diagnosis of blood complex tachycardia. Lancet 7: 672-675 (1988) 31. Rankin, A.C., Goldroyd, K., Chong, E., Rae, A.P., Cobbe, S.M.: Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias. Br. Heart J. 62: 195-203 (1988) 32. Lee, J., Heo, J., Ogilby, J.D., Cave, V., Iskandrian, B., Iskandrian, A S.: Atrioventricular block during adenosine thallium imaging. Am. Heart J. 123: 1569-1574 (1992) 33. Mohuiddin, S.M., Gupta, N.C., Esterbrooks, D.J., Hineman, D.E.: Safety profile of intravenous adenosine in cardiac imaging (Abstract). Circulation 82: 731 (1991) 34. Mason, J.R., Palac, R.T., Freeman, M.L. et al.: Thallium scintigraphy during dobutamine infusion: non-exercise dependent screening test for coronary artery disease. Am. Heart J. 707: 481-485 (1984) 35. Pennell, D.J., Underwood, S.R., Ell, P.J.: Dobutamine Thallium myocardial perfusion tomography in patients with asthma. Am. J. Cardiol. (in press) 36. Pennell, D.J., Underwood, S.R., Swanton, R.H., Walker, J.M., Ell, P.J.: Dobutamine thallium-201 myocardial perfusion tomography. JACC 73: 1471-1479 (1991) 37. Warltier, D.C., Zyvoloski, M., Gross, G.J., Hardman, H.F., Brooks, H.L.: Redistribution of myocardial blood flow distal to a dynamic coronary artery stenosis by sympathomimetic amines. Comparison of dopamine, dobutamine and isoproterenol. Am. J. Cardiol. 46: 269-279 (1981 ) 38. Josephson, M.A., Brown, B.G., Hecht, H.S., Hopkins, J., Pierce, C.D., Petersen, R.N.: Noninvasive detection and localisation of coronary stenoses in patients: comparison of resting dipyridamole and exercise thallium-201 myocardial perfusion imaging. Am. Heart J. 103: 1008-1018 (1982) |
|
Relative Papers |
Online ISSN 1011-6575
Άρθρα Δημοσιευμένα σε αυτό το Περιοδικό Καταχωρούνται στα:
- Chemical Abstracts
- Elsevier’s Bibliographic Databases: Scopus, EMBASE, EMBiology, Elsevier BIOBASE SCImago Journal and Country Rank Factor
Articles published in this Journal are Indexed or Abstracted in: • Chemical Abstracts • Elsevier’s Bibliographic Databases: Scopus, EMBASE, EMBiology, Elsevier BIOBASE SCImago Journal and Country Rank Factor
Συντακτικη Επιτροπή-Editorial Board
ΕΤΗΣΙΑ ΣΥΝΔΡΟΜΗ 1992 – ANNUAL SUBSCRIPTION 1992 | |
Γλώσσα Πλήρους Κειμένου – Full Text Language | Αγγλικά – English |
Παραγγελία – Αγορά – Order – Buy | Ηλεκτρονική Μορφή: pdf (70 €) – Digital Type: pdf (70 €)
pharmakonpress[at]pharmakonpress[.]gr |
Έντυπη Μορφή (70 € + έξοδα αποστολής) – Printed Type (70 € + shipping)
pharmakonpress[at]pharmakonpress[.]gr |