Prolonged Myocardial Ischemia after Intravenous Dipyridamole Thallium Imaging

Lewen, Marc K.; Labovitz, Arthur J.; Kern, Morton J.; Chaitman, Bernard R.

doi:10.1378/chest.92.6.1102

Cited by 35 publications

(5 citation statements)

References 10 publications

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“…2,3 However, side-effects caused by dipyridamole administration are frequent and can be life-threatening, because of its prolonged pharmacologic effect (15-30 min when administered intravenously), and it is often necessary to eliminate side-effects with intravenous aminophylline infusion. [4][5][6][7] Dipyridamole is thought to be an indirect coronary vasodilator, and it acts by blocking the cellular uptake of the primary vasodilator, adenosine, and leads to subsequent increases in myocardial and arterial wall adenosine concentrations. Thallium-201 myocardial perfusion SPECT with adenosine has recently been introduced in Japan.…”

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confidence: 99%

Safety of and Tolerance to Adenosine Infusion for Myocardial Perfusion Single-Photon Emission Computed Tomography in a Japanese Population

Hatanaka

Doi

Hirohata

et al. 2007

Circ J

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harmacologic coronary vasodilation in combination with single-photon emission computed tomography (SPECT) is a safe and effective method for the diagnosis of coronary artery disease. 1 Dipyridamole in conjunction with thallium imaging has been widely used as an alternative to exercise for patients unable to perform adequate exercise stress testing. 2,3 However, side-effects caused by dipyridamole administration are frequent and can be life-threatening, because of its prolonged pharmacologic effect (15-30 min when administered intravenously), and it is often necessary to eliminate side-effects with intravenous aminophylline infusion. [4][5][6][7] Dipyridamole is thought to be an indirect coronary vasodilator, and it acts by blocking the cellular uptake of the primary vasodilator, adenosine, and leads to subsequent increases in myocardial and arterial wall adenosine concentrations. Thallium-201 myocardial perfusion SPECT with adenosine has recently been introduced in Japan. Compared to dipyridamole, the side-effects of adenosine are also frequent but are mild, transient and well tolerated and do not require aminophylline administration because the plasma half-life of adenosine is exceedingly short (2-10 s), 8 and its effects disappear promptly upon discontinuation of adenosine infusion. 9 The short half-life of adenosine and the ability to regulate its infusion rate are useful properties, allowing for easy control of pharmacologic coronary vasodilation. However, adenosine is a very potent arteriolar vasodilator that can cause myocardial ischemia via a coronary steal phenomenon and can also decrease atrioventricular (AV) node conduction velocity. 10 In this study, we assessed the safety of and tolerance to thallium-201 myocardial perfusion SPECT with intravenous adenosine infusion in Japanese patients with suspected coronary artery disease. Methods PatientsDuring the period September 2005 to July 2006, 206 consecutive Japanese patients (106 men, 100 women; mean age, 68.9±10.5 years; range, 33-89 years) underwent thallium-201 myocardial perfusion SPECT with intravenous adenosine infusion for the evaluation of possible coronary artery disease. The research protocol was approved by the Institutional Review Board of the Sumitomo Besshi Hospital (Niihama, Japan), and patients were enrolled in the study after providing written informed consent. Exclusion criteria included hypotension (systolic blood pressure <90 mmHg), Circ J 2007; 71: 904 -910 (Received October 17, 2006; revised manuscript received February 8, 2007; accepted February 28, 2007 Safety of and Tolerance to Adenosine Infusion for Myocardial Perfusion Single-Photon Emission Computed Tomography in a Japanese PopulationKunihiko Hatanaka, MD* , *** , ****; Masayuki Doi, MD*; Satoshi Hirohata, MD*** , ****; Shigeshi Kamikawa, MD*; Yoko Kaji, MD*; Tsutomu Katoh, MD**; Shozo Kusachi, MD****; Yoshifumi Ninomiya, MD***; Tohru Ohe, MD**** Background Adenosine has been available for use in myocardial perfusion single-photon emission computed tomography (SPECT) in J...

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confidence: 99%

Safety of and Tolerance to Adenosine Infusion for Myocardial Perfusion Single-Photon Emission Computed Tomography in a Japanese Population

Hatanaka

Doi

Hirohata

et al. 2007

Circ J

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“…To date, only four cases have been reported in the literature of MI induced after adenosine infusion . Similarly, only four cases of MI have been reported with dipyridamole infusion . The mechanisms responsible for MI following adenosine or dipyridamole infusion have been postulated but are still largely unknown.…”

Section: Discussionmentioning

confidence: 99%

“…1,[9][10][11] Similarly, only four cases of MI have been reported with dipyridamole infusion. [12][13][14][15] The mechanisms responsible for MI following adenosine or dipyridamole infusion have been Although counterintuitive, vasodilators have been shown to induce ischemia and infarction as a result of coronary steal. Several varieties of steal phenomenon have been described.…”

Section: Regadenason Induced Myocardial Infarction Shah Et Al E91mentioning

confidence: 99%

Acute Myocardial Infarction During Regadenoson Myocardial Perfusion Imaging

Parra

Rosenstein

2013

Pharmacotherapy

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Pharmacologic stress testing uses vasodilators to provide objective evidence of myocardial ischemia. Adenosine and dipyridamole are nonselective adenosine receptor agonists that have been associated with myocardial infarction (MI) during intravenous infusion. Mechanisms postulated for this effect include coronary steal, transmural steal, global hypotension, and direct vasoconstriction. Regadenoson, a direct A2A agonist, was approved for use in stress testing in 2008. We describe a 68-year-old man who presented to our institution with typical angina, relieved by nitroglycerin. He did not have electrocardiogram (ECG) changes suggestive of myocardial pathology, and laboratory testing did not reveal a significant rise in troponin-I levels. To further assess the etiology of his symptoms, he underwent a pharmacologic stress test with regadenoson followed by technetium 99 m sestamibi. Six minutes after regadenoson infusion, the patient developed severe retrosternal chest pain accompanied by ST elevations on ECG. Sublingual nitroglycerin was administered that resolved both the pain and ECG changes. The patient subsequently underwent urgent coronary angiography and was found to have a 95% critical stenosis involving the left anterior descending artery. We conclude this case represents a MI secondary to coronary steal phenomenon induced by regadenoson infusion. Clinicians should be aware this adverse effect can occur despite the improved side-effect profile of regadenoson. Continuous monitoring of vital signs and the ECG with regular assessment of symptoms is imperative to identify this rare but potentially devastating adverse event.

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“…Dipyridamole is one of the most used drugs to cause myocardial ischemia with segmentary contraction abnormalities on two-dimensional echocardiography 58 , with sensitivity similar to that of thallium-201 myocardial perfusion scintigraphy. With this drug, which has a relatively long persistence, episodes of severe ischemia, myocardial infarction, and even death, though rare, have been reported [58][59][60] . Coronary vasodilation produced ley dipyridamole is due to its blocking effect on cellular uptake of adenosine, which results in an increase in endogenous adenosine, therefore potentiating its vasodilating effect 61,62 .…”

Section: Discussionmentioning

confidence: 99%