Adenosine triphosphate stress myocardial perfusion imaging for risk stratification of patients aged 70 years and older with suspected coronary artery disease

Yao, Zhiming; Zhu, Hui; Li, Wenchan; Chen, Congxia; Wang, Hua; Shi, Lei; Zhang, Wenjie

doi:10.1007/s12350-015-0355-5

Cited by 15 publications

(11 citation statements)

References 12 publications

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“…We believe that our study provides further data on the predictors of inadequate stress in stress CMR. The use of ATP is prevalent in the Asia Pacific region [16][17][18][19], and our data are likely relevant and similar to those of other Asia Pacific CMR centers. Further research is required to determine if the same predictors can be replicated in other populations.…”

supporting

confidence: 76%

“…This is probably attributable to our protocol of relatively low ATP infusion rate (140 mcg/kg/ min) for 4 min. From the literature, ATP can be infused intravenously at 160 mcg/kg/min for 5 min [10,[12][13][14][15][16][17][18][19][20]22]. Karamitsos et al [4] found that age and reduced EF were the predictors of inadequate response.…”

Section: Discussionmentioning

confidence: 99%

“…ATP infusion rates in some centers have been set at 160 mcg/ kg/min for 5 min [10,[12][13][14][15][16][17][18][19][20]. The purpose of this retrospective study is to identify the proportion of patients with inadequate stress using a lower dose 140 mcg/kg/min protocol and to determine the factors related to inadequate stress in ATP stress CMR.…”

Section: Statistical Analysesmentioning

confidence: 99%

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Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

Cheng

Lam

et al. 2018

Cardiovasc Imaging Asia

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Adenosine triphosphate (ATP) is an established pharmacological agent for stress cardiovascular magnetic resonance (CMR) in the Asia Pacific region. Inadequate cardiac stress in a CMR study may lead to false-negative results. The aim of the present study is to identify the proportion of patients with inadequate stress using a 140 mcg/kg/min protocol and the factors for inadequate stress in ATP stress CMR. Materials and Methods: A retrospective analysis from January to December 2017 was performed. In total, 150 patients underwent ATP stress perfusion CMR at 1.5 tesla. All patients received ATP infusion of 140 mcg/kg/min for 4 min. Adequate stress was defined as two or more of the following criteria: 1) positive splenic switch off sign, 2) increased heart rate ≥10 bpm, and 3) drop in systolic blood pressure ≥10 mm Hg. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors of inadequate response to ATP. Basic demographic variables with p-value ≤0.2 were examined for inclusion in the model. A p-value less than 0.05 was considered significant. Results: Fifty-six (37%) patients did not demonstrate adequate cardiac stress response. Non-responders to ATP more often had atrial fibrillation, higher indexed left ventricular end systolic volume, and lower ejection fraction. Multivariable logistic regression analysis showed that low body weight and male gender were consistent independent predictors of inadequate stress in all models. Conclusion: Inadequate stress occurred in 37% of subjects with ATP infusion of 140 mcg/kg/ min. Low body weight and male gender are independent predictors of inadequate response to ATP. Higher infusion rates of ATP should be considered in patients with inadequate stress.

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supporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

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Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

Cheng

Lam

et al. 2018

Cardiovasc Imaging Asia

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“…There are also fewer side effects with intravenous infusion ATP than adenosine, an important factor in the clinical setting [24,25]. Accordingly, ATP is widely used as a pharmacologic stress agent instead of adenosine for stress myocardial perfusion imaging, mainly in Asian countries [26][27][28][29] and some European countries [23,25]. ATP is administered intravenously at 0.16 mg/kg/min [22,[24][25][26][27][28][29].…”

Section: Pharmacological Stressorsmentioning

confidence: 99%

Assessment of Myocardial Ischemia Using Stress Perfusion Cardiovascular Magnetic Resonance

Yamada

Ishida

Kitagawa

et al. 2018

Cardiovasc Imaging Asia

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Coronary artery disease (CAD) is a major cause of mortality and morbidity throughout the world, and its prevalence is expected to increase worldwide. Myocardial ischemia is a strong predictor of future adverse outcomes in patients with suspected CAD. The detection of ischemia is an important part of the diagnostic strategy for patients with suspected CAD. Stress myocardial perfusion cardiovascular magnetic resonance (CMR) is a noninvasive diagnostic approach for the detection of myocardial ischemia. CMR offers several advantages over single-photon emission computed tomography, such as high spatial resolution and no radiation exposure. Stress perfusion CMR offers high diagnostic performance for the detection of CAD and prognostic value in patients with suspected CAD. In this review, we describe how to perform stress perfusion CMR and interpret its findings. We also discuss recent updates concerning the diagnostic and prognostic value of stress perfusion CMR in patients with suspected CAD.

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“…The latter, which will be the focus of our discussion, include dipyridamole, adenosine, adenosine triphosphate (ATP) and regadenoson (Table 1). Of the vasodilator agents mentioned, ATP, the pharmacologic stress agent used in the study by Yao et al, 1 is not approved for use in the United States but is being used in other parts of the world including Japan and China.…”

mentioning

confidence: 99%

Vasodilator stress agents for myocardial perfusion imaging

Saab

Hage

2017

Journal of Nuclear Cardiology

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In this issue of the Journal, Yao et al report on the prognostic value of adenosine triphosphate (ATP) myocardial perfusion imaging (MPI) with Technetium-99 sestamibi (Tc-99m) in a population aged 70 years and older.1 The ability to exercise in this population is expected to be rather limited. A total of 415 patients with suspected coronary artery disease (CAD) were identified and retrospectively enrolled in the study. The primary composite end point was major adverse cardiac events (MACE) and included death from a cardiac etiology, nonfatal myocardial infarction (MI), and late coronary revascularization ([60 days). Sixteen patients met exclusion criteria as they underwent early coronary revascularization B60 days after MPI. Reversible and/or fixed perfusion defects were considered abnormal and patients were followed over a mean of 3.45 ± 1.71 years. MACE occurred in 37 patients, including 9 cardiac deaths, and was significantly lower in patients with normal MPI, even after adjusting for other variables such as age [80 years, male gender, chest pain or dyspnea, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, atrial fibrillation, and abnormal ATP stress ECG. Each of the individual outcomes included in MACE was also significantly lower in patients with normal MPI. In addition, although patients aged C80 years had higher MACE rates than those aged 70-79 years when the summed stress score (SSS) was [8, the two groups had similar MACE rates when the SSS was B8. These results confirm the prognostic value of ATP-MPI in an elderly population with suspected CAD.The proportion of pharmacologic stress tests performed in the United States has steadily increased over the past several decades. Exercise stress testing is favored over vasodilator stress, since it is more physiological and since it assesses the functional capacity which provides important prognostic information.

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Adenosine triphosphate stress myocardial perfusion imaging for risk stratification of patients aged 70 years and older with suspected coronary artery disease

Abstract: ATP-MPI data are useful for the prediction of major adverse cardiac events in patients aged 70 years and older with suspected CAD.

Cited by 15 publications

References 12 publications

Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

Assessment of Myocardial Ischemia Using Stress Perfusion Cardiovascular Magnetic Resonance

Vasodilator stress agents for myocardial perfusion imaging

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