Thomas G S, Prill N V, Majmundar H, Fabrizi R R, Thomas J J, Hayashida C, Kothapalli S, Payne J L, Payne M M, Miyamoto M I
Mission Internal Medical Group, Mission Viejo, Calif. 92691, USA.
J Nucl Cardiol. 2000 Sep-Oct;7(5):439-46. doi: 10.1067/mnc.2000.108030.
Combining low-level treadmill exercise with adenosine infusion may result in fewer bradyarrhythmic complications by increasing sympathetic tone and may improve myocardial perfusion image quality by decreasing background activity.
Patients referred for outpatient pharmacologic stress myocardial perfusion imaging performed simultaneous treadmill exercise (mean 2.2 metabolic equivalents) throughout 6-minute adenosine infusion (adenosine-exercise n = 507). Patients unable to exercise and those with left bundle branch block received adenosine infusion alone (adenosine-nonexercise n = 286). Adverse reaction data were collected on all patients and compared by sex. Background-to-target activity was calculated in a blinded fashion on 200 randomly selected patients.
During the period from April 1996 to December 1998, 507 patients (64%) underwent adenosine-exercise testing, whereas 286 (36%) underwent adenosine-nonexercise testing. Hypotensive and arrhythmic (atrioventricular block, sinus bradycardia, and new onset atrial fibrillation or flutter) adverse reactions occurred less often during adenosine-exercise than during adenosine-nonexercise. Neither death nor myocardial infarction occurred in either group. In the adenosine-exercise group, 2.8% of patients experienced an adverse reaction versus 5.6% of the adenosine-nonexercise group (P = .04). The reduction in adverse reactions occurred in both men and women, although women had significantly more adverse reactions than men (5.7% vs 1.8%, P = .004). Liver/heart and gut/heart ratios were lower in the adenosine-exercise group (1.05+/-0.42 vs. 1.21+/-0.55 , P = .01; 0.61+/-0.21 vs. 0.69+/-0.24, P = .03, respectively).
Compared with adenosine infusion alone, combining low-level treadmill exercise with adenosine in outpatients is safe, better tolerated, and improves image quality. Women were more likely to experience adverse reactions than men.
低强度平板运动与腺苷输注相结合，可能通过增加交感神经张力减少缓慢性心律失常并发症，并通过降低本底活性改善心肌灌注图像质量。
因门诊药物负荷心肌灌注成像就诊的患者在6分钟腺苷输注全程同时进行平板运动（平均2.2代谢当量）（腺苷-运动组n = 507）。无法运动的患者及左束支传导阻滞患者仅接受腺苷输注（腺苷-非运动组n = 286）。收集所有患者的不良反应数据并按性别进行比较。对200例随机选择的患者以盲法计算本底与靶区活性比值。
1996年4月至1998年12月期间，507例患者（64%）接受了腺苷-运动试验，而286例（36%）接受了腺苷-非运动试验。腺苷-运动试验期间低血压和心律失常（房室传导阻滞、窦性心动过缓以及新发房颤或房扑）不良反应的发生频率低于腺苷-非运动试验期间。两组均未发生死亡或心肌梗死。腺苷-运动组2.8%的患者出现不良反应，而腺苷-非运动组为5.6%（P = 0.04）。不良反应的减少在男性和女性中均有发生，尽管女性的不良反应明显多于男性（5.7%对1.8%，P = 0.004）。腺苷-运动组的肝/心和肠/心比值较低（分别为1.05±0.42对1.21±0.55，P = 0.01；0.61±0.21对0.69±0.24，P = 0.03）。
与单纯腺苷输注相比，门诊患者将低强度平板运动与腺苷相结合是安全的，耐受性更好，且能改善图像质量。女性比男性更易出现不良反应。
