Simultaneous low level treadmill exercise and intravenous dipyridamole stress thallium imaging

Casale, Paul N.; Guiney, Timothy E.; Strausś, H. William; Boucher, Charles A.

doi:10.1016/0002-9149(88)91225-8

Cited by 69 publications

(21 citation statements)

References 12 publications

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“…This significantly reduces the side effects and improves image quality. [23][24][25][26] Low-level exercise supplementation is not recommended for patients with LBBB, WPW, and ventricular pacing due to heart rate-related imaging artifacts.…”

Section: Dipyridamolementioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

529

386

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Section: Dipyridamolementioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

529

386

View full text Add to dashboard Cite

“…Patients performing the combined strategy of dipyridamole followed by low exercise levels achieved higher target heart rate, higher heart to liver count, and had fewer noncardiac side effects. 26 Patients referred for intravenous dipyridamole thallium studies should have theophylline derivatives stopped 48 hours prior to testing, and caffeinated beverages or substances should be withheld several hours prior to testing. Both aminophylline and caffeine exert their action through the inhibition of phosphodiesterase.…”

Section: Methodsmentioning

confidence: 99%

Update on intravenous dipyridamole cardiac imaging in the assessment of ischemic heart disease

Younis

Chaitman

1990

Clinical Cardiology

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Summary: Intravenous dipyridamole is a relative selective coronary vasodilator which, when combined with thallium-20 1 , provides a useful technique to assess myocardial perfusion. The intravenous dipyridamole is administered as an infusion at a rate of 0.14 mg/kg/min for 4 minutes. In the presence of significant coronary artery disease the increase of coronary blood flow is disproportionate between vessels with and without significant coronary lesions, providing the basis for detecting regional differences in flow using thallium-201. The test can be used alone or combined with low level exercise to increase test sensitivity. The test is safe when performed under medical supervision and when patient selection is done appropriately. Most of the side effects induced by dipyridamole infusion are well tolerated by patients and readily reversed with intravenous aminophylline and sublingual nitroglycerin. The average sensitivity and specificity of the dipyridamole thallium scintigraphy test from the major studies are 76% and 70%, respectively. The test is very useful in providing prognostic information in patients who are unable to exercise. A reversible thallium defect after dipyridamole infusion has been shown to be associated with significant mortality and morbidity in patients with documented or suspected comnary artery disease. The use of intravenous dipyridamole has been extended into other modalities of imaging, including 2- dimensional and Doppler echocardiography , to study functional changes in the left ventricular induced by the infusion of intravenous dipyridamole. Like other noninvasive tests, intravenous dipyridamole thallium scintigraphy has its own limitations, including the absence of standard physiologic data which are acquitwl during exercise testing, the need to stop theophylline or its derivatives 48 hours prior to testing, and a relatively low yield of ischemic electrocardiographic changes. It is anticipated that intravenous dipyridamole will soon be commercially available.

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“…Failure to achieve adequate heart rate limits the sensitivity of exercise stress testing for the detection of coronary heart disease, resulting in a substantial number (up to 25%) of false-negative results. 3,4 The current options for such patients are to accept the potential loss of sensitivity for the detection of coronary artery disease or to reschedule the patient for a pharmacologic (i.e., adenosine or regadenoson) stress test.…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The Both Exercise and Regadenoson Stress Test (BERST) trial

Ross

Wilkins

et al. 2013

Journal of Nuclear Cardiology

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Background. The data existing in the literature regarding the safety of using regadenoson with symptom-limited exercise are limited, which motivated the authors to undertake this randomized study.Methods. We offered patients scheduled to undergo vasodilator stress nuclear myocardial perfusion imaging the opportunity to exercise instead. Patients who failed to reach target heart rate (THR) were randomized to (1) receive regadenoson at peak exercise or (2) stop exercise and receive regadenoson at rest. Patients who reached THR received a standard Tc-99m sestamibi injection with no regadenoson.Results. 200 patients were included (66% male, mean age 52.5 ± 13.6). 125 patients (62%) reached THR with exercise alone. All stress protocols were well tolerated, and there were no significant adverse events. There were no statistically significant differences in the extent of perfusion abnormalities, image quality, or rate of referral to cardiac catheterization within 60 days between the groups. In fully adjusted logistic regression models, beta-blocker use and diabetes remained significant univariate predictors of failure to reach THR (OR 0.21, 95% CI 0.1-0.5, P < .0001, OR 0.34, 95% CI 0.2-0.7, P 5 .004, respectively).Conclusions. A protocol combining regadenoson at peak exercise in patients unable to reach THR with exercise is feasible, well-tolerated, and yields comparable imaging results to a standard regadenoson injection at rest. In addition, pharmacologic stress testing may be overordered in current clinical practice, as patients referred for such testing were often able to exercise. (J Nucl

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Simultaneous low level treadmill exercise and intravenous dipyridamole stress thallium imaging

Cited by 69 publications

References 12 publications

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Update on intravenous dipyridamole cardiac imaging in the assessment of ischemic heart disease

Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The Both Exercise and Regadenoson Stress Test (BERST) trial

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