Nahser P J, Brown R E, Oskarsson H, Winniford M D, Rossen J D
Department of Internal Medicine, University of Iowa, College of Medicine, Iowa City, USA.
Am J Card Imaging. 1996 Jul;10(3):149-53.
Myocardial perfusion imaging with adenosine pharmacological stress may be useful in patients with obstructive lung disease who are unable to exercise. However, these patients are often treated with medications containing theophylline, which is an adenosine antagonist. This study assessed the effect of aminophylline on coronary vasodilation produced by intravenous adenosine as commonly used during cardiac imaging. Changes in coronary flow velocity (measured by intracoronary Doppler catheter) heart rate, arterial pressure and changes in coronary resistance were measured during intravenous infusion of adenosine at 140 micrograms/kg/min before and after aminophylline, 6 mg/kg intravenously in 12 patients. After aminophylline infusion, the theophylline level averaged 14 +/- 1 microgram/mL. The coronary hemodynamic effects of adenosine were markedly attenuated by aminophylline. Adenosine increased coronary blood flow velocity by 192 +/- 39% at control and 78 +/- 16% after aminophylline (P < .05 v control). Adenosine produced a 63 +/- 5% decrease in coronary vascular resistance at control and 40 +/- 6% (P < .05) after aminophylline. The utility of myocardial imaging techniques using coronary vasodilation with intravenous adenosine may be reduced in patients treated with theophylline-containing preparations.
对于无法进行运动的阻塞性肺病患者，腺苷药物负荷心肌灌注成像可能有用。然而，这些患者常使用含茶碱的药物进行治疗，而茶碱是一种腺苷拮抗剂。本研究评估了氨茶碱对心脏成像时常用的静脉注射腺苷所产生的冠状动脉扩张的影响。在12例患者静脉注射氨茶碱6mg/kg前后，以140μg/kg/min的速度静脉输注腺苷期间，测量冠状动脉血流速度（通过冠状动脉内多普勒导管测量）、心率、动脉压以及冠状动脉阻力的变化。输注氨茶碱后，茶碱水平平均为14±1μg/mL。氨茶碱显著减弱了腺苷的冠状动脉血流动力学效应。腺苷使冠状动脉血流速度在对照时增加192±39%，在氨茶碱治疗后增加78±16%（与对照相比，P<.05）。腺苷使冠状动脉血管阻力在对照时降低63±5%，在氨茶碱治疗后降低40±6%（P<.05）。在接受含茶碱制剂治疗的患者中，使用静脉注射腺苷进行冠状动脉扩张的心肌成像技术的效用可能会降低。
