Study Of Domestic-made Adenosine Stress Myocardial Perfusion Imaging In Diagnosis Of Coronary Artery Disease

PrefaceStress test in conjunction with radionuclide myocardial perfusion imaging has become a widely used noninvasive method of diagnosing coronary artery disease , risk stratification and therapy assessment. Stress tests include sub - maximal exercise test and pharmacological stress test. Dipyridamole and adenosine are the only two kinds of medicine that admitted by American Food and Drug Administration. Adenosine is prior to dipyridamole because of its excellent safety records and shorter side effect lasting time. But adenosine was rarely used in China before because it is expensive and domestic - made adenosine was not a-vailable.ObjectiveThe aim of this study is to evaluate the feasibility, safety and diagnostic accuracy of domestic - made adenosine stress myocardial perfusion imaging in diagnosis of coronary artery disease in patients with suspected coronary artery disease.MethodThe study group included 60 in - patients or out - patients with suspected coronary artery disease. They were divided randomly into two equal groups. 30 patients underwent adenosine stress test and the other 30 patients underwent exercise stress test. All patients underwent rest myocardial perfusion imaging 24 hours before the stress test. The patients' heart rates, blood pressures were recorded before adenosine perfusion and 3 minutes, 6 minutes and 11 minutes af-ter adenosine perfusion, all kinds of side effects during adenosine perfusion were recorded at the same time too.ResultsNo patients required premature termination of adenosine infusion or treatments of aminophyline, and many side effects of adenosine infusion were noted. The frequency of side effects was 73. 3% (22/30 patients) , but most of them were mild and transient.Patients'hearts rates increased slightly and blood pressure decreased slightly after adenosine infusion, and both of them fell down to normal level rapidly after adenosine infusion.There were no significant differences between rest lung/heart ratios of adenosine group and exercise group, and between adenosine stress lung/heart ratios and exercise stress. Stress lung/heart ratios were significant higher than rest lung/heart ratios in both groups.Myocardial ischemia was found in 65. 38% patients of adenosine group and in 72.41% patients of exercise group. There were no significant differences between two groups.DiscussionExogenous adenosines combine with A2a receptor after infusion and increase the blood flow of normal artery territory, but blood flow of ischemic territory supplied by a stenotic coronary artery can not be changed. Thus a perfusion defect can be found in stress images contrasting with rest images.In most situations, a multi - stage sub - maximal exercise test is the preferred stress modality because it is s physiologic stress that affords important prognostic information. However, exercise depends on the patients' condition and cooperation. A considerable number of patients with suspected or proven coronary disease may have limited ability to achieve sub - maximal exercise stress because of severe left ventricular dysfunction, acute pulmonary hyperten-sion, acute or serious non - cardiac disorders, severe physical handicap, old age or comorbid disease.Adenosine is prior to dipyridamole because of its excellent safety records and shorter side effect lasting time. The results of our study demonstrate that although the side effects were frequent, but most of them were mild and transient. Adenosine stress myocardial perfusion imaging is similar with exercise stress test in diagnosis of coronary artery disease.ConclusionDomestic - made adenosine is comparable to abroad adenosine, in adenosine stress myocardial perfusion imaging test in detecting coronary artery disease. The side effects are mild and transient; the examination is safe and feasible.