Circulation, Vol 82, 80-87, Copyright © 1990 by American Heart Association
MS Verani, JJ Mahmarian, JB Hixson, TM Boyce and RA Staudacher
Pharmacological coronary vasodilation induced by dipyridamole is often used
in association with thallium-201 myocardial scintigraphy to evaluate the
presence and prognostic significance of coronary artery disease. Because
dipyridamole acts by blocking the cellular uptake of adenosine, we
investigated the usefulness of direct intravenous administration of
adenosine, a physiological substance with an exceedingly short (less than 2
seconds) plasma half-life, to induce maximal controlled coronary
vasodilation in conjunction with 201Tl scintigraphy. We studied 89 patients
(44 men and 45 women; mean age, 64 +/- 10 years [SD]) who were unable to
perform an exercise test and were referred for evaluation of suspected
coronary artery disease. The intravenous infusion of adenosine began at an
initial rate of 50 micrograms/kg/min and was increased by stepwise
increments every minute to a maximal rate of 140 micrograms/kg/min. 201Tl
was injected intravenously after 1 minute at the highest infusion rate,
followed by immediate and delayed (4 hour) tomographic imaging. At the
highest infusion rate, adenosine induced a significant (p less than 0.001)
decrease in systolic (8.7 +/- 19.3 mm Hg) and diastolic (6.7 +/- 9.4 mm Hg)
blood pressures as well as a significant (p = 0.0001) increase in heart
rate (14.5 +/- 11.0 beats/min). Side effects occurred in 83% of the
patients but resolved spontaneously within 1 or 2 minutes after
discontinuing the adenosine infusion. Chest, throat, or jaw pain were the
most frequent symptoms and occurred in 57% of the patients. Headache (35%)
and flush (29%) were also common. Ischemic electrocardiographic changes
occurred in 12% of the patients, and transient first-degree
atrioventricular block occurred in 10%.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.
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