Botvinick Elias H
Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0214, USA.
J Nucl Med Technol. 2009 Mar;37(1):14-25. doi: 10.2967/jnmt.108.057802.
This article presents the exciting advances made and ongoing in the area of pharmacologic cardiac stress testing. In particular, new A(2A)-specific receptor agonists work like adenosine but promise the delivery of uncomplicated vasodilator stress testing or the diagnosis and prognosis of coronary disease. These agents, although not perfect, do likely present a level of protection against the complications of bronchospasm and heart block. Phase III studies have shown that these agents promise a reduced symptom intensity and greater patient tolerance. One of these agents, regadenoson, is now Food and Drug Administration approved and will be delivered as the same single-dose bolus in all patients, regardless of weight, greatly simplifying the method and increasing its acceptability. Most widely applied with myocardial perfusion SPECT, these agents will find application with PET myocardial perfusion studies and likely MRI studies. Because of their effect on coronary supply rather than demand, they will not be applied with stress echocardiography. Before considering these agents, we will consider the principles and methods of stress testing, and particularly pharmacologic stress testing. The learning objectives of this article are to familiarize the reader with the methods and choices in stress testing for coronary disease diagnosis and prognosis, to present the advantages and disadvantages of pharmacologic stress testing, to review current pharmacologic stress-testing methods and their specific combination with imaging methods, to present the chemistry and effects of the new A(2a)-specific receptor agonists and their advantages compared with existing nonspecific agents, and to help the reader better understand the clinical role of the A(2a)-specific receptor agonists and their application.
本文介绍了药物心脏负荷试验领域已取得的令人振奋的进展以及正在进行的研究。特别是，新型A(2A)特异性受体激动剂的作用类似于腺苷，但有望实现简单的血管扩张剂负荷试验或冠心病的诊断与预后评估。这些药物虽然并非完美，但确实可能对支气管痉挛和心脏传导阻滞并发症提供一定程度的保护。Ⅲ期研究表明，这些药物有望减轻症状强度并提高患者耐受性。其中一种药物——瑞加德松，现已获得美国食品药品监督管理局批准，并且无论患者体重如何，均采用相同的单剂量推注给药，这极大地简化了方法并提高了其可接受性。这些药物在心肌灌注单光子发射计算机断层显像（SPECT）中应用最为广泛，也将用于正电子发射断层显像（PET）心肌灌注研究以及可能的磁共振成像（MRI）研究。由于它们作用于冠状动脉供血而非需求，因此不会用于负荷超声心动图检查。在考虑这些药物之前，我们将先探讨负荷试验的原则和方法，特别是药物负荷试验。本文的学习目标是使读者熟悉冠心病诊断和预后评估中负荷试验的方法和选择，介绍药物负荷试验的优缺点，回顾当前的药物负荷试验方法及其与成像方法的具体结合，阐述新型A(2a)特异性受体激动剂的化学性质和作用及其与现有非特异性药物相比的优势，并帮助读者更好地理解A(2a)特异性受体激动剂的临床作用及其应用。
