Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Stress Testing and Imaging Protocols for Myocardial Perfusion Studies

심근관류영상을 위한 심근부하 방법 및 검사 프로토콜

  • Kim, Seong-Min (Department of Nuclear Medicine, College of Medicine, Chungnam National University)
  • 김성민 (충남대학교 의과대학 핵의학교실)
  • Published : 2009.06.30
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Abstract

Scince $^{201}$TI was introduced as a myocardial perfusion imaging agent in the early 1970s, scintigraphic evaluation of myocardial perfusion for the diagnosis of coronary artery disease is a valuable noninvasive diagnostic imaging modality. Stress radionuclide myocardial perfusion imaging is widely accepted to have high diagnostic and prognostic use in the assessment of patients with known or suspected coronary artery disease. With wise use of this nonivasive imaging technique, more patients are referred for stress perfusion imaging. Until now various protocols for stress testing and myocardial imaging were developed and used in worldwide. This article presented various protocols of stress testing and myocardial imaging for clinical use.

Keywords

References

  1. Brown KA. Prognostic value of thallium-201 myocardial perfusion imaging. A diagnostic tool comes of age. Circulation 1991;83:363-81 https://doi.org/10.1161/01.CIR.83.2.363
  2. Brown KA. Prognostic value of myocardial perfusion imaging: state of the art and new developments. J Nucl Cardiol 1996;3:516-37 https://doi.org/10.1016/S1071-3581(96)90061-6
  3. Kotler TS, Diamond GA. Exercise thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease. Ann Intern Med 1990;113:684-702 https://doi.org/10.7326/0003-4819-113-9-684
  4. Braunwald E, Samoff SJ, Case RB, Stainsby WN, Welch GH Jr. Hemodynamic determinants of coronary flow: effect of changes in aortic pressure and cardiac output on the relationship between myocardial oxygen consumption and coronary flow. Am J Physiol 1958;192:157-63
  5. Susie D, Frohlich ED. Coronary circulation in the hypertension: flow and flow reserve. J Myocard Ischemia 1995;7:62-67
  6. Hoffman JI. Coronary circulation, cardiac hypertrophy and myocardial ischemia. In: Safar ME, Fouad-Tazari F, editors. The Heart in Hypertension. Dordrecht. Kluwer Academy Publishera; 1989. p. 243-598
  7. Gould KL, Lipscomb K, Hamilton GW. Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am J Cardiol 1974;33:87-94. https://doi.org/10.1016/0002-9149(74)90743-7
  8. Klocke FJ. Measurements of coronary flow reserve: defining pathophysiology versus making decisions about patient care. Circulation 1987;76:1183-9 https://doi.org/10.1161/01.CIR.76.6.1183
  9. Beller GA, Holzgrefe HH, Watson DD. Effects of dipyridamoleinduced vasodilation on myocardial uptake and clearance kinetics of thallium-201. Circulation 1983;68: 1328-38 https://doi.org/10.1161/01.CIR.68.6.1328
  10. Beller GA, Holzgrefe HH, Watson DD. Intrinsic washout rates of thallium-201 in normal and ischemic myocardium after dipyridamole-induced vasodilation. Circulation 1985;71:378-86 https://doi.org/10.1161/01.CIR.71.2.378
  11. Becker LC. Conditions for vasodilator-induced coronary steal in experimental myocardial ischemia. Circulation 1978;57:1103-10 https://doi.org/10.1161/01.CIR.57.6.1103
  12. Epstein SE, Cannon RO 3rd, Talbot TL. Hemodynamic principles in the control of coronary blood flow. Am J Cardiol 1985;56:4E-10E https://doi.org/10.1016/0002-9149(85)91169-5
  13. Beller GA. Clinical nuclear cardiology. Philadelphia: WB Saunders, 1995: p. 98
  14. Botvinick EH. Stress imaging: current clinical options for the diagnosis, localization and evaluation of coronary artery disease. Med Clin N Amer 1995;79:1025-61 https://doi.org/10.1016/S0025-7125(16)30019-0
  15. Botvinick EH. Current methods of phannacologic stress testing and the potential advantages of new agents. J Nucl Med Technol 2009;37:14-25 https://doi.org/10.2967/jnmt.108.057802
  16. Iskandrian AS, Heo J, Kong B, Lyons E. Effect of exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients. J Am Coll Cardiol 1989;14:1477-86 https://doi.org/10.1016/0735-1097(89)90385-9
  17. Heller GV, Ahmed I, Tikemeier PL, Barbour MM, Garber CE. Influence of exercise intensity on the presence, distribution, and size of thallium-201 defects. Am Heart J 1992;123:909-16 https://doi.org/10.1016/0002-8703(92)90695-R
  18. Beller GA. Relative merits of cardiovascular diagnostic techniques. In: Braunwald E, Zipes DP, Libby P, editors. Heart disease, 6th ed. Philadelphia: WB Sanuders; 2001. p. 426
  19. Esquivel L, Pollock SG, Beller GA, Gibson RS, Watson DO, Kaul S, Effect of the degree of effort on the sensitivity of the exercise thallium-201 stress test in symptomatic coronary artery disease, Am J Cardiol 1989;63:160-5 https://doi.org/10.1016/0002-9149(89)90278-6
  20. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 1996;93:905-14 https://doi.org/10.1161/01.CIR.93.5.905
  21. Henzlova MJ, Cerqueira MD, Hasen CL, Tailefer R, Yao SS, Stress protocols and tracrs. http://www.asnc.orgisection73.cfin January 2009. American Society of Nuclear Cardiology. Available from: URL: http://www.asnc.orgisection_73.cfin. Last updated January 16, 2009, 22. Tavel ME. Stress testing in cardiac evaluation: Current concepts with emphasis on the ECG. Chest 2001;119:907 https://doi.org/10.1378/chest.119.3.907
  22. Tavel ME. Stress testing in cardiac evaluation: Current concepts with emphasis on the ECG. Chest 2001;119:907 https://doi.org/10.1378/chest.119.3.907
  23. Satran A, Hendel RC. Performing test: Exercise and Pharmacologic Stress Testing. In: Heller GV, Hendel RC, editors. Nuclear Cardiology: Practical Appilcations. New york: McGrawHill;2004. p.121-124
  24. Verani MS. Adenosine thallium-201 myocardial perfusion scintigraphy. Am Heart J 1991;122:269-78 https://doi.org/10.1016/0002-8703(91)90800-W
  25. Travain MI, Wexler JP. Pharmacological stress testing. Semin Nucl Med 1999;29:298-318 https://doi.org/10.1016/S0001-2998(99)80018-X
  26. Marchant E, Pichard AD, Casanegra P, Lindsay J. Effect of intravenous dipyridamole on regional coronary blood flow with I-vessel coronary artery disease: evidence against coronary steal. Am J Cardiol 1984;53:718-21 https://doi.org/10.1016/0002-9149(84)90392-8
  27. DePuey EG, Rozanski A. Pharmacological and other nonexercise alternatives to exercise testing to evaluate myocardial perfusion and left ventricular function with radionuclides. Semin Nucl Med 1991;21:92-101 https://doi.org/10.1016/S0001-2998(05)80047-9
  28. Klabunde RE. 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
  29. Moser GH, Schrader J, Deussen A. Turnover of adenosine in plasma of human and dog blood. Am J Physiol 1989;256:C799-806 https://doi.org/10.1152/ajpcell.1989.256.4.C799
  30. 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
  31. O"Keefe JH, Bateman TM, Handlin LR, Barnhart CS. Fourversus 6-minute infusion protocol for adenosine thallium-201 single photon emission computed tomography imaging. Am Heart J 1995;129:482-7 https://doi.org/10.1016/0002-8703(95)90272-4
  32. DePuey EG, Corbett JR, Friedman JD, Goldstein RA, Henzlova MJ, Hansen DL, et al. Imaging guidelines for nuclear cardiology procedures-December 2006. American Society of Nuclear Cardiology. http://www.asnc.orgisection73.cfm. Accessed January 3, 2007
  33. Treuth MG, Reyes GA, He ZX, et al. Tolerance and diagnostic accuracy of an abbreviated adenosine infusion for myocardial scintigraphy: a randomized, prospective study. J Nucl Card 2001;8:548-54 https://doi.org/10.1067/mnc.2001.116167
  34. Rossen JD, Stemberg RG, Lopez JAG, et al. Coronary dilation with intravenous dipyridamole and adenosine: a comparative study [abstract]. Circulation 1990;82:III-731
  35. Coma-Canella I. Dobutamine stress test to diagnose the resence and severity of coronary artery lesions in angina. Eur Heart J 1991;12:1198-204 https://doi.org/10.1093/eurheartj/12.11.1198
  36. Mazeika PK, Nadazdin A, Oakley CM. Dobutamine stress echocardiography for detection and assessment of coronary artery disease. J Am Coll Cardiol 1992;19:1203-11 https://doi.org/10.1016/0735-1097(92)90325-H
  37. Previtali M, Lanzarini L, Ferrario M, Tortorici M, Mussini A, Montemartini C. Dobutamine versus dipyridamole echocardiography in coronary artery disease. Circulation 1991;83:III27-31
  38. Martin TW, Seaworth JF, Johns JP, Pupa LE, Condos WR. Comparison of adenosine, dipyridamole, and dobutamine in stress echocardiography. Ann Intern Med 1992;116:190-6 https://doi.org/10.7326/0003-4819-116-3-190
  39. 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
  40. Geleijnse ML, Elhendy A, Fioretti PM, Roelandt JR Dobutamine stress myocardial perfusion imaging. J Am Coll Cardiol 2000;36:2017-27 https://doi.org/10.1016/S0735-1097(00)01012-3
  41. Pennell DJ, Mavrogeni SI, Forbart SM, Karwatowski SP, Underwood SR Adenosine combined with dynamic exercise for myocardial perfusion imaging. J Am Coll Cardiol 1995;25:1300-9 https://doi.org/10.1016/0735-1097(95)00011-R
  42. Vitola JV, Brambatti JC, Caligaris F, Lesse CR, Nogueira PR, Joaquim AI, et al. Exercise supplementation to dipyridamole prevents hypotension, improves electrocardiogram sensitivity, and increases heart-to-liver activity ratio on Tc-99m sestamibi imaging. J Nucl Cardiol 2001;8:652-9 https://doi.org/10.1067/mnc.2001.117204
  43. Elliott MD, Holly TA, Leonard SM, Hendel RC. Impact of an abbreviated adenosine protocol incorporating adjunctive treadmill exercise on adverse effects and image quality in patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2000;7:584-9 https://doi.org/10.1067/mnc.2000.108737
  44. Thomas GS, Prill NV, Majmundar H, Fabrizi RR, Thomas JJ, Hayashida C, et al. Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality. J Nucl Cardiol 2000;7:439-46 https://doi.org/10.1067/mnc.2000.108030
  45. Muller-Suur R, Eriksson SV, Strandberg LE, Mesko L. Comparison of adenosine and exercise stress test for quantitative perfusion imaging in patients on beta-blocker therapy. Cardiology 2001;95:112-8 https://doi.org/10.1159/000047356
  46. Vitola JV, Brambatti JC, Caligaris F, Lesse CR, Nogueira PR, Joaquim AI, et al. Exercise supplementation to dipyridamole prevents hypotension, improves electrocardiogram sensitivity, and increases heart-to-liver activity ratio on Tc-99 m sestamibi imaging. J Nucl Cardiol 2001;8:652-9 https://doi.org/10.1067/mnc.2001.117204
  47. Stein L, Burt R, Oppenheim B, Schauwecker D, Fineberg N. Symptom-limited arm exercise increases detection of ischemia during dipyridamole tomographic thallium stress testing in patients with coronary artery disease. Am J Cardiol 1995;75:568-72
  48. Verzijlbergen JF, Vermeersch PHMJ, Laarman G-J, Ascoop CAPL. Inadequate exercise leads to suboptimal imaging. Thallium-201 myocardial perfusion imaging after dipyridamole combined with low-level exercise unmasks ischemia in symptomatic patients with non-diagnostic thallium-201 scans who exercise submaximally. J Nucl Med 1991;32:2071-8
  49. Hashimoto A, Palmer EL, Scott JA, Abraham SA, Fischman AJ, Force TL, et al. Complications of exercise and pharmacologic stress tests: Differences in younger and elderly patients. J Nucl Cardiol 1999;6:612-9 https://doi.org/10.1016/S1071-3581(99)90098-3
  50. Thomas GS, Miyamoto MI. Should simultaneous exercise become the standard for adenosine myocardial perfusion imaging? Am J Cardiol 2004;94:3-10 https://doi.org/10.1016/j.amjcard.2004.04.009
  51. Pennell DJ, Forbat SM, Karwatowski SP, Mavrogeni S, Underwood SR Adenosine combined with exercise for thallium-201 myocardial tomogaphy improves imaging and reduces side effects. Br Heart J 1993;69:62 https://doi.org/10.1136/hrt.69.1_Suppl.S62
  52. Thomas GS, Prill NV, Majmundar H, Fabrizi RR, Thomas JJ, Hayashida C, et al. Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality. J Nucl Cardiol 2000;7:439-46 https://doi.org/10.1067/mnc.2000.108030
  53. Samady H, Wackers FJ, Joska TM, Joska TM, Zaret BL, Jain D. Pharmacologic stress perfusion imaging with adenosine: Role of simultaneous low-level treadmill exercise. J Nucl Cardiol 2002;9:188-96 https://doi.org/10.1067/mnc.2002.119973
  54. Stem SI, Greenberg D, Come RA. Quantitation of walking exercise required for improvement of dipyridamole thallium-201 image quality. J Nucl Med 1992;33:2061-6
  55. Casale PN, Guiney TE, Strauss W, Boucher CA Simultaneous low level treadmill exercise and intravenous dipyridamole stress thallium imaging. Am J Cardiol 1988;62:799-802
  56. Laarman GJ, Niemeyer MG, van der Wall EE, Verzijlbergen FJ, Bruschke AV, Ascoop CA. Dipyridamole thallium testing: Noncardiac side effects, cardiac effects, electrocardiographic changes and hemodynamic changes after dipyridamole infusion with and without exercise. Int J Cardiol 1988;20:231-8 https://doi.org/10.1016/0167-5273(88)90267-7
  57. Kim SM. Protocols of myocardial perfusion SPECT. Kor J Nucl Med 2005;39:82-6
  58. Zaret BL, Strauss HW, Martin ND, Wells HP Jr, Flamm MD Jr. Noninvasive regional myocardial perfusion with radioactive potassium. Study of patients at rest, with exercise and during angina pectoris. N Engl J Med 1973;288:809-12 https://doi.org/10.1056/NEJM197304192881602
  59. Ellestad MH. Stress testing: Principles and Practice. 4th ed. Philadelphia: FA Davis 1995
  60. Rroelicher VF, Myers J. Exercise and Heart, 3rd ed. Philadelphia: WB Saunders 1999
  61. Chiatrnan BR. Exercise testing. In: Braunwald E, Zipes DP, Libby P, editors. Heart Disease, 6th ed. Philadelphia: WB Saunders; 2001. p. 133
  62. Miyamoto MI, Vernotico SL, Majmundar H, Thomas GS. Pharmacologic stress myocardial perfusion imaging: a practical approach. J Nucl Cardiol 2007;14:250-5 https://doi.org/10.1016/j.nuclcard.2007.01.006
  63. Zarret BL. Nuclear cardiology; state of the art a future direction. 2nd ed. St. Louis: Mosby 1999. p. 237-98
  64. Kiat H, Germano G, FriedmanJ, Van Train K, Silagan G, Wang FP, et al. Comparative feasibility of separate or simultaneous rest thallium-201/stress technetium-99m-sestamibi dual-isotope myocardial perfusion SPECT. J Nucl Med 1994;35:542-8
  65. Siebel ink HM, Natale D, Sinusas AJ, Wackers FJ. Quantitative comparison of single-isotope and dual-isotope stress-rest singlephoton emission computed tomographic imaging for reversibility of defects. J Nucl Cardiol 1996;3:483-93 https://doi.org/10.1016/S1071-3581(96)90058-6