The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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Current Trends and Future Development in Pharmacologic Stress Testing

약물부하 검사법의 현재와 미래

  • Bae, Jin-Ho (Department of Nuclear Medicine, Kyungpook National University Medical School) ;
  • Lee, Jae-Tae (Department of Nuclear Medicine, Kyungpook National University Medical School)
  • 배진호 (경북대학교 의과대학 핵의학교실) ;
  • 이재태 (경북대학교 의과대학 핵의학교실)
  • Published : 2005.04.30
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Abstract

Pharmacologic stress testing for myocardial perfusion imaging is a widely used noninvasive method for the evaluation of known or suspected coronary artery disease. The use of exercise for cardiac stress has been practiced for over 60 years and clinicians are familial with its using. However, there are inevitabe situations in which exorcise stress is inappropriate. A large number of patients with cardiac problems are unable to exercise to their full potential due to comorbidity such as osteoarthritis, vascular disease and pulmonary disease and a standard exercise stress test for myocardial perfusion imaging is suboptimal means for assessment of coronary artery disease. This problem has led to the development of the pharmacologic stress test and to a great increase in its popularity. All of the currently used pharmacologic agents have well-documented diagnostic value. This review deals the physiological actions, clinical protocols, safety, nuclear imaging applications of currently available stress agents and future development of new vasodilating agents.

Keywords

References

  1. Young DZ, Guiney TE, McKusick KA, Okada RD, Strauss HW, Boucher CA. Unmasking potential myocardial ischemia with dipyridamole thallium imaging in patients with normal submaximal exercise thallium tets. Am J Noninvas Cardiol 1987;1:11-14
  2. Nishimura S, Mahmarian JJ, Boyce TM, Verani MS. Equivalence between adenosine and exercise thallium-201 myocardial tomography: a multicenter, prospective, crossover trial. J Am Coll Cardiol 1992;20:265-75 https://doi.org/10.1016/0735-1097(92)90090-A
  3. Robert C. Hendel, MD, Tariq Jamil, MD, David K. Glover, ME. Pharmacologic stress testing: New methods and new agents. J Nucl Cardiol 2003;10:197-204 https://doi.org/10.1067/mnc.2003.5
  4. Topol EJ, Nissen SE. Our Preoccupation With Coronary Luminology : The Dissociation Between Clinical and Angiographic Findings in Ischemic Heart Disease. Circulation 1995;92:2333-42 https://doi.org/10.1161/01.CIR.92.8.2333
  5. Linden J, Thai T, Figler H, Jin X, Robeva AS. Characterization of human A(2B) adenosine receptors:radioligand binding, western blotting, and coupling to G(q) in human embryonic kidney 293 cells and HMC-1 mast cells. Mol Pharmacol 1999;56:705-13
  6. Auchampach JA, Jin X, Wan TC, Caughey GH. Linden J. Canine mast cell adenosine receptors: cloning and expression of the A3 receptor and evidence that degranulation is mediated by the A2B receptor. Mol Pharmacol 1997;52:846-60
  7. Bertolet BD, Elizabeth LB, Wilmer FW, Richard NA. Kerensky, Hill JA. Selective attenuation by N-0861 (N6-endonorboran- 2-yl-9-methyladenine) of cardiac A1 adenosine receptor-mediated effects in humans. Circulation 1996;93:1871-6 https://doi.org/10.1161/01.CIR.93.10.1871
  8. Nagashima S, Moore HJ, Kernensky R. Dose ranging study of N-0861, a selective A1 adenosine receptor antagonist, in patients receiving adenosine [abstract]. J Am Coll Cardiol 1994;23;874A
  9. Gaspardone A, Crea F, Versaci F. Muscular and cardiac adenosine induced pain is mediated by A1 receptors. J Am Coll Cardiol 1995;25:251-70 https://doi.org/10.1016/0735-1097(94)00352-Q
  10. Moser G H, Schrader J, Deussen A. Turnover of adenosine in plasma of human and dog blood. Am J physiol 1989;256:C799- C806
  11. Klabunde R E. Dipyridamole inhibition of adenosine metabolism in human blood. Eur J Pharmacol 1983;93:21-6 https://doi.org/10.1016/0014-2999(83)90026-2
  12. 이명철, 정준기. 심장핵의학. 고려의학; 2002. p.44-51
  13. Ell PJ, Gambhir SS. Nuclear medicine in clinical diagnosis and treatment. 3rd ed. Churchil Livingstone; 2004. p. 1093-1107
  14. 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;185:485-91
  15. Chan SY, Brunken RC, Czernin J. Comparision of maximal myocardial blood flow during adenosine infusion with that of intravenous dipyridamole in normal man. J Am Coll Cardiol 1992;20:979-85 https://doi.org/10.1016/0735-1097(92)90201-W
  16. Wioson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD. Effects of adenosine on human coronary arterial circulation. Circulation 1990;82:1595-606 https://doi.org/10.1161/01.CIR.82.5.1595
  17. Kim JK, Ahn BC, Chun KA, Hyun DW, Lee YH, Bae SK, et al. Safety profile of adenosine myocardial perfusion imaging. Kor J Circulation 1997;27:189-81
  18. Nguyen T, Heo J, Ogilby JD, Iskandrian AS. Single photon emission computed tomography with 201Tl during adenosineinduced coronary hyperemia : correlation with coronary arteriography, exercise thallium imaging and two-dimensional echocardiography. J Am Coll Cardiol 1990;16:1375-83 https://doi.org/10.1016/0735-1097(90)90379-4
  19. O'Keefe JH Jr, Bateman TM, Handlin LR, Barnhart CS. Four-vresus 6 minute infusion protocol for adenosine $^{201}Tl $single photon emission computed tomography imaging. Am Heart J 1995;129:482-7 https://doi.org/10.1016/0002-8703(95)90272-4
  20. Kang SW, Woo EJ, Chae SC, Jun JE, Park WH, Chung BC, et al. Adenosine Tc-99m MIBI scintigraphy in the diagnosis of coronary artery disease: Comparision with exercise Tc-99m MIBI scintigraphy. Kor J Nucl Med 1992;26:72-81
  21. O'Keefe JH , Bateman TM, silvestri R, Barnhart C. Safety and diagnostic accuracy of adenosine $^{201}Tl $ scintigraphy in patients unable to exercise and those with left bundle branch block. Am Heart J 1992;124:614-21 https://doi.org/10.1016/0002-8703(92)90268-Z
  22. Abreu A, Mahmarian JJ , Nishimura S, Boyce TM, Verani MS. Tolerance and safety of pharmacologic coronary vasodilation with adenosine in association with $^{201}Tl $ scintigraphy in patients with suspected coronary artery disease. J AM Coll Cardiol 1991;18: 730-5 https://doi.org/10.1016/0735-1097(91)90796-C
  23. Sylven C, Beermann B, Jonzon B, Brandt R. Angina pectoris like pain provoked boy intravenous adenosine in healthy volunteers. Br Med J 1986;293:227-30 https://doi.org/10.1136/bmj.293.6541.227
  24. Sylven C, Borg G, Brandt R, Beermann B, Jonzon B. Dose effect relationship of adenosine provoked angina petoris like pain- a study of the psychophysical power function. Eur Heart J 1988;9:87-91 https://doi.org/10.1093/eurheartj/9.suppl_E.87
  25. Lee J, Heo J, Ogilby JD, Cave V, Iskandrian B, Iskandrian AS. Atrioventricular block during adenosine thallium imaging. Am Heart J 1992;123:1569-73 https://doi.org/10.1016/0002-8703(92)90811-9
  26. Benedini G, Cuccia C, Bolognesi R. value of purinic compounds in assessing sinus node dysfunction in man : a new diagnostic method. Eur Heart J 1984;5:394-403
  27. Pennel DJ, Mahmood S, Ell PJ, Underwood SR. Bradycardia progressing to cardiac arrest during adenosine thallium myocardial perfusion imaging in occult sino-atrial disease. Eur J Nucl Med 1994;21:170-2
  28. Curnish RR, Berne RM, Rubio R. 1972 Effect of aminophylline on myocardial reactive hyperemia. Proc Soc Exp Biol Med 1972;141: 593-8
  29. Kenakin TP. The potentiation of cardiac response to adenosine by benzodiazepines. J Pharmacol Exp Ther 1982;222:752-8
  30. Cushley MJ, Tattersfield AE, Holgate ST. Inhaled adenosine and guanosine on airway resistance in normal and asthmatic subjects. Br J Clin Pharmacol 1983;15:161-5 https://doi.org/10.1111/j.1365-2125.1983.tb01481.x
  31. Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS. Safety profile of adenosine stress perfusion imaging : results from the Adenoscan Multicenter Trial Registry. J AM Coll Cardiol 1994;23:384-9 https://doi.org/10.1016/0735-1097(94)90424-3
  32. Polad JE, Wilson LM. Myocardial infarction during adenosine stress test. Heart 2002;87:E2
  33. Gould KL. Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. Physiologic basis and experimental validation. Am J Cardiol 1978;41:267-78 https://doi.org/10.1016/0002-9149(78)90165-0
  34. Travain MI, Wexler JP. Pharmacological stress testing. Semin Nucl Med 1999;29:298-318 https://doi.org/10.1016/S0001-2998(99)80018-X
  35. Brown BG, Josephson MA, Petersen RB, Pierce CD, Wong M, Hecht HS, et al. Intravenous dipyridamole combined with isometric handgrip for near maximal coronary flow in patients with coronary artery disease. Am J Cardiol 1981;48:1077-85 https://doi.org/10.1016/0002-9149(81)90323-4
  36. Foulds T, Mackinnon J.Controlled double blind trial of Persantin in treatment of angina pectoris. Br Med J 1960;241:835-8
  37. Kinsella D, Troup W, McGregor M. Studies with a new coronary vasodilator drug:persantin. Am Heart J 1962;63:146-51 https://doi.org/10.1016/0002-8703(62)90190-4
  38. Homma S, Callahan RJ, Ameer B, McKusick KA, Strauss HW, Okada RD, et al. Usefulness of oral dipyridamole suspension for stress thallium imaging without exercise in the detection of coronary artery disease. Am J Cardiol 1986;57:503-9 https://doi.org/10.1016/0002-9149(86)90824-6
  39. Gould KL, Sorenson SG, Albro P, Caldwell JH, Chaudhuri T, Hamilton GW. Thallium-201 myocardial imaging during coronary vasodilation induced by oral dipyridamole. J Nucl Med 1986;27: 31-6
  40. Borges-Neto S, Mahmarian JJ , Jain A, Roberts R, Verani MS. Quantitative thallium-201 single photon emission tomography after oral dipyridamole for assessing the presence, anatomi location and severity of coronary artery disease. J Am Coll Cardiol 1988;11: 962-9 https://doi.org/10.1016/S0735-1097(98)90052-3
  41. Beer S, Heo J, Kong B, Lyons E, Iskandrian A. 1989 Use of oral dipyridamole SPECT thallium-201 imaging in detection of coronary artery disease. Am Heart J 1989;118:1022-7 https://doi.org/10.1016/0002-8703(89)90238-X
  42. Segall GM, Davis MJ. Variability of serum drug level following a single oral dose of dipyridamole. J Nucl Med 1988;29:1662-7
  43. Ranhosky A, Rawson J. The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Circulation 1990;81:1205-9 https://doi.org/10.1161/01.CIR.81.4.1205
  44. Pennell DJ, Underwood SR, Ell PJ. Symptomatic bradycardia complicating the use of intravenous dipyridamole for $^{201}Tl $ myocardial perfusion imaging. Int J Cardiol 1990;27:272-274 https://doi.org/10.1016/0167-5273(90)90170-A
  45. Pennell DJ, Ell PJ. Atrial fibrillation after intravenous dipyridamole for $^{201}Tl $ myocardial perfusion imaging. Eur J Nucl Med 1992;19:1064-5
  46. Bayliss J, Pearson M, Sutton GC. Ventricular dysrhythmias following intravenous dipyridamole during stress myocardial imaging. Br J Radiol 1983;56:686-692 https://doi.org/10.1259/0007-1285-56-669-686
  47. Cushley MJ, Tallant N, Holgate ST. The effect of dipyridamole on histamine and adenosine induced bronchoconstriction in normal and asthmatic subjects. Eur J Respir Dis 1985;67:185-192
  48. Wilson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD. Effects of adenosine on human coronary arterial circulation. Circulation 1990;82:1595-606 https://doi.org/10.1161/01.CIR.82.5.1595
  49. Miyagawa M, Kumano S, Sekiya M, Watanabe K, Akutzu H, Imachi T, et al. Thallium-201 myocardial tomography with intravenous infusion of adenosine triphosphate in diagnosis of coronary artery disease. J Am Coll Cardiol 1995;26:1196-201 https://doi.org/10.1016/0735-1097(95)00304-5
  50. Watanabe K, Sekiya M, Ikeda S, Miyagawa M, Kinoshita M, Kumano S. Comparison of adenosine triphosphate and dipyridamole in diagnosis by thallium-201 myocardial scintigraphy. J Nucl Med 1997;38:577-81
  51. Takeishi Y, Takahashi N, Fujiwara S, Atsumi H, Takahashi K, Tomoike H. Myocardial tomography with technetium-99m tetrofosmin during intravenous infusion of adenosine triphosphate. J Nucl Med 1998;39:582-6
  52. Tuttle R R, Milis J. Dobutamine, development of a new catecholamine to selevtively increase cardiac contractility. Circ Res 1975;36:185-96 https://doi.org/10.1161/01.RES.36.1.185
  53. Leier CV, Heban PT, Huss P, Bush CA, Lewis RP. Comparative systemic and regional haemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation 1978;58:466-75 https://doi.org/10.1161/01.CIR.58.3.466
  54. Willerson JT, Hutton I, Watson JT, Platt MR, Templeton GH. Influence of dobutamine on regional myocardial blood flow and ventricular performance during acute and chronic myocardial ischemia in dogs. Circulation 1976;53:828-33 https://doi.org/10.1161/01.CIR.53.5.828
  55. Warltier DC, Zyvlowski M, Gross GJ, Hardman HF, Brooks HL. Redistribution of myocardial blood flow distal to a dynamic coronary arterial stenosis by sympathomimetic amines. Comparison of dopamine, dobutamine and isoproterenol. Am J Cardiol 1981;48:269-79 https://doi.org/10.1016/0002-9149(81)90607-X
  56. Meyer SL, Curry GC, Donsky MS, Twieg DB, Parkey RW, Willerson JT. Influence of dobutamine on haemodynamics and coronary blood flow in patients with and without coronary artery disease. Am J Cardiol 1976;38:103-8 https://doi.org/10.1016/0002-9149(76)90070-9
  57. Iskandrian AS, verani MS, Heo J. Pharmacologic stress testing : mechanism of action, hemodynamic responses, and results in detection of coronary artery disease. J Nucl Cardiol 1994;1:94-111 https://doi.org/10.1007/BF02940016
  58. Pennell DJ, Underwood SR, Swanton RH, Walker JM, Ell PJ. Dobutamine thallium myocardial perfusion tomography. J Am Coll Cardiol 1991;18:1471-9 https://doi.org/10.1016/0735-1097(91)90677-2
  59. Wallbridge DR, Tweddel AC, Martin W, Hutton I. A comparison of dobutamine and maximal exercise as stress for thallium scintigraphy. Eur J Nucl Med 1993;20:319-23
  60. Pellikke PA, Oh JK, Bailey KR, Nichols BA, Monahan KH, Tajik AJ. Dynamic intraventricular obstruction during dobutamine stress echocardiography: A new observation. Circulation 1992;86: 1429-32 https://doi.org/10.1161/01.CIR.86.5.1429
  61. Rosamund TL, Vacek JL, Hurwitz A, Rowland AJ, Beauchamp GD, Crouse LJ. Hypotension during dobutamine stress echocardiography : initial description and clinical relevance. Am Heart J 1992;123:403-7 https://doi.org/10.1016/0002-8703(92)90652-C
  62. Dakik HA, Vempathy H, Verani MS. Tolerance, hemodynamic changes, and safety of dobutamine stress perfusion imaging. J Nucl Cardiol 1996;3:410-4 https://doi.org/10.1016/S1071-3581(96)90076-8
  63. Elhendy A, Valkema R, van Domburg RT, Bax JJ, Nierop PR, Cornel JH, et al. Safety of dobutamine-atropine stress myocardial perfusion scintigraphy. J Nucl Med 1998;39:1662-6
  64. tein I. Observation on the action of ergonovine on the coronary circulation and its use in the diagnosis of coronary artery insufficiency. Am Heart J 1949;37:36-45 https://doi.org/10.1016/0002-8703(49)91427-1
  65. Payne RM, Horowitz LD, Mullins CM. Comparison of isometric exercise and angiotensin infusion as stress test for evaluation of left ventricular function. Am J Cardiol 1973;31:428-35 https://doi.org/10.1016/0002-9149(73)90290-7
  66. Glover DK, Ruiz M, Takehana K, Petruzella FD, Riou LM, Rieger JM, et al. Pharmacological stress myocardial perfusion imaging with the potent and selective A(2A) adenosine receptor agonists ATL193 and ATL146e administered by either intravenous infusion or bolus injection. Circulation 2001;104:1181-7 https://doi.org/10.1161/hc3601.093983
  67. Trochu JN, Zhao G, Post H, Xu X, Belardinelli L, Belloni FL, Hintze TH. Selective A2A adenosine receptor agonist as a coronary vasodilator in conscious dogs: potential for use in myocardial perfusion imaging. J Cardiovasc Pharmacol 2003;41:132-139 https://doi.org/10.1097/00005344-200301000-00017
  68. Cerqueira MD. The future of pharmacologic stress: selective A2A adenosine receptor agonists. Am J Cardiol 2004;94:33D-40D https://doi.org/10.1016/j.amjcard.2004.04.017
  69. He ZX, Cwajg E, Hwang W, Hartley CJ, Funk E, Michael LH, et al. Myocardial blood flow and myocardial uptake of (201)Tl and (99m)Tc-sestamibi during coronary vasodilation induced by CGS- 21680, a selective adenosine A(2A) receptor agonist. Circulation 2000;102:438-44 https://doi.org/10.1161/01.CIR.102.4.438