A comparison of adenosine and exercise stress 201Tl scintigraphy

Abstract

A detailed comparison of stress thallium images utilizing exercise (symptom-limited bicycle ergonometer) and adenosine (infused at 50 micrograms kg-1 min-1 increasing by 25 micrograms kg-1 min-1 every 2 min to a maximum tolerated dose) was performed in 20 patients with angiographically documented coronary disease. Ten patients were receiving beta-blockade at the time of both tests. Triple-, double- and single-vessel disease was present in eight, seven and five patients, respectively. Exercise produced a large increase in double product (8970 +/- 288 to 20,-984 +/- 690 mm Hg min-1) while adenosine produced no significant change (8440 +/- 280 to 9086 +/- 600 mm Hg min-1). Each of the three gated planar images (anterior 40 degrees and 70 degrees left anterior oblique) was divided into five equal segments. Exercise produced 44/90, 44/95 and 45/95 abnormal segments in the anterior, 40 degrees and 70 degrees views while adenosine produced 53/100, 44/100 and 52/100 abnormal segments for the same views. The total number of abnormal segments was similar in both groups (133/280 exercise and 149/300 adenosine). Each abnormal segment was analysed for degree of change between stresses using a five-point scoring system. Exercise produced eight segments which were larger by one point and 44 segments larger by two points while adenosine produced 17 and 44 segments larger by one and two points respectively. Left ventricular uptake (as % injected dose) was significantly greater in the adenosine group (1.12 +/- 0.06% versus 0.64 +/- 0.05%, P < 0.01) but right ventricular uptake was similar (0.15 +/- 0.1% versus 0.14 +/- 0.09%).(ABSTRACT TRUNCATED AT 250 WORDS)