Jamil G, Ahlberg A W, Elliott M D, Hendel R C, Holly T, McGill C C, Sarkis M, White M P, Mather J F, Waters D D, Heller G V
Division of Cardiology, Hartford Hospital, Connecticut 06102-5037, USA.
Am J Cardiol. 1999 Aug 15;84(4):400-3. doi: 10.1016/s0002-9149(99)00323-9.
Limited exercise combined with dipyridamole increases myocardial perfusion defect severity compared with dipyridamole alone. The impact of limited exercise combined with adenosine on myocardial perfusion defect severity is unknown. This study compares myocardial perfusion defect severity with adenosine alone and adenosine combined with limited exercise. Thirty-two patients with coronary artery disease underwent on separate days and in randomized order technetium-99m sestamibi (25 to 30 mCi) single-photon emission computed tomographic imaging at rest, after adenosine (140 microg/kg/min x 6 minutes), and after adenosine (140 microg/kg/min x 4 minutes) during 6 minutes of modified Bruce treadmill exercise (adenosine-exercise). Radiopharmaceutical was injected at 3 and 5 minutes during adenosine and adenosine-exercise, respectively. Images were interpreted by a consensus agreement of 3 nuclear cardiologists without knowledge of patient identity, stress protocol, or clinical data using a 17-segment model and 5-point scoring system. A summed stress score (SSS), summed rest score (SRS), and summed difference (SSS-SRS) score (SDS) were calculated for each image. Peak stress heart rate and rate-pressure product were higher for adenosine-exercise than adenosine (102 +/- 19 vs 81 +/- 11 beats/min and 13,972 +/- 4,265 vs 10,623 +/- 2,131, respectively; both p <0.001). Sensitivity for detection of > or = 50% coronary stenosis was 75% and 72% for adenosine-exercise and adenosine, respectively (p = NS). There were no differences in SSS and SDS between adenosine-exercise and adenosine (8.2 +/- 5.9 vs 8.1 +/- 6.3 and 4.9 +/- 4.1 vs 5.2 +/- 4.6, respectively; both p = NS). Thus, in patients with coronary artery disease, limited treadmill exercise combined with adenosine does not increase myocardial perfusion defect severity compared with standard adenosine technetium-99m sestamibi single-photon emission computed tomographic myocardial perfusion imaging.
与单独使用双嘧达莫相比，有限运动联合双嘧达莫会增加心肌灌注缺损的严重程度。有限运动联合腺苷对心肌灌注缺损严重程度的影响尚不清楚。本研究比较了单独使用腺苷以及腺苷联合有限运动时心肌灌注缺损的严重程度。32例冠心病患者在不同日期按随机顺序接受了锝-99m甲氧基异丁基异腈（25至30mCi）单光子发射计算机断层扫描成像，分别在静息状态、腺苷（140μg/kg/分钟×6分钟）后以及在改良的布鲁斯跑步机运动6分钟期间（腺苷-运动组，腺苷140μg/kg/分钟×4分钟）进行扫描。在腺苷组和腺苷-运动组中，分别在腺苷注射3分钟和5分钟时注射放射性药物。由3名核心脏病专家在不知道患者身份、负荷方案或临床数据的情况下，采用17节段模型和5分评分系统达成共识解读图像。为每张图像计算总负荷评分（SSS）、总静息评分（SRS）和总差值评分（SSS - SRS，SDS）。腺苷-运动组的峰值负荷心率和心率-血压乘积高于腺苷组（分别为102±19次/分钟对81±11次/分钟和13972±4265对10623±2131；两者p<0.001）。腺苷-运动组和腺苷组检测≥50%冠状动脉狭窄的敏感性分别为75%和72%（p=无显著性差异）。腺苷-运动组和腺苷组之间的SSS和SDS无差异（分别为8.2±5.9对8.1±6.3和4.9±4.1对5.2±4.6；两者p=无显著性差异）。因此，在冠心病患者中，与标准的腺苷锝-99m甲氧基异丁基异腈单光子发射计算机断层扫描心肌灌注成像相比，有限的跑步机运动联合腺苷不会增加心肌灌注缺损的严重程度。
