Reduced adverse effects with an accelerated dobutamine stress protocol compared with the conventional protocol: a prospective, randomized myocardial perfusion scintigraphy study

Abstract Background We aimed to compare the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) without known coronary artery disease. Methods Two-hundred twenty-nine ESRD patients who applied for kidney transplantation at our centre were prospectively evaluated by MPS and DSE. The primary endpoint was a composite of myocardial infarction (MI) or all-cause mortality. The secondary endpoint included MI or coronary revascularization (CR) not triggered by MPS or DSE at baseline. Results MPS detected reversible ischemia in 31 patients (13.5%) and fixed perfusion defects in 13 (5.7%) patients. DSE discovered stress-induced wall motion abnormalities (WMAs) in 28 (12.2%) and at rest in 18 (7.9%) patients. MPS and DSE results agreed in 85.6% regarding reversible defects (κ = 0.358; P < .001) and in 90.8% regarding fixed defects (κ = 0.275; P < .001). Coronary angiography detected relevant stenosis > 50% in only 15 of 38 patients (39.5%) with pathological findings in MPS and/or DSE. At a median follow-up of 8 years and 10 months, the primary endpoint occurred in 70 patients (30.6%) and the secondary endpoint in 24 patients (10.5%). The adjusted Cox hazard ratios (HRs) for the primary endpoint were 1.77 (95% CI 1.02-3.08; P = .043) for perfusion defects in MPS and 1.36 (95% CI 0.78-2.37; P = ns) for WMA in DSE. The secondary endpoint was significantly correlated with the findings of both modalities, MPS (HR 3.21; 95% CI 1.35-7.61; P = .008) and DSE (HR 2.67; 95% CI 1.15-6.20; P = .022). Conclusion Perfusion defects in MPS are a stronger determinant of all-cause mortality, MI and the need for future CR compared with WMAs in DSE. Given the complementary functional information provided by MPS vs DSE, results are sometimes contradictory, which may indicate differences in the underlying pathophysiology.

Download Full-text

Myocardial perfusion scintigraphy for evaluation of ST-segment elevation during dobutamine stress test in patients with myocardial infarction

Journal of Nuclear Cardiology ◽

10.1016/s1071-3581(05)80093-5 ◽

1995 ◽

Vol 2 (2) ◽

pp. S1-S1

Author(s):

A ELHENDY ◽

M GELEJNSE ◽

J CORNEL ◽

G ELSAID ◽

R DOMBURG ◽

...

Keyword(s):

Myocardial Infarction ◽

Myocardial Perfusion ◽

Myocardial Perfusion Scintigraphy ◽

Stress Test ◽

Dobutamine Stress ◽

Perfusion Scintigraphy ◽

St Segment Elevation ◽

Dobutamine Stress Test ◽

St Segment

Download Full-text

Myocardial perfusion scintigraphy in Germany

Nuklearmedizin ◽

10.1055/s-0037-1621023 ◽

2007 ◽

Vol 46 (02) ◽

pp. 49-55 ◽

Cited By ~ 7

Author(s):

W. Burchert ◽

F. M. Bengel ◽

R. Zimmermann ◽

J. vom Dahl ◽

W. Schäfer ◽

...

Keyword(s):

Nuclear Medicine ◽

Myocardial Perfusion ◽

Attenuation Correction ◽

Working Group ◽

Primary Care Physicians ◽

Gated Spect ◽

Myocardial Perfusion Scintigraphy ◽

German Society ◽

University Hospitals ◽

Perfusion Scintigraphy

SummaryThe working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: A questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (>75%) was performed with 99mTc-MIBI or tetrofosmin. 201Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: In Germany, MPS is predominantly performed with 99mTc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization.

Download Full-text

Paradoxical Hypotension during Dobutamine Infusion for Myocardial Perfusion Scintigraphy

Nuklearmedizin ◽

10.1055/s-0038-1632347 ◽

1998 ◽

Vol 37 (08) ◽

pp. 268-271

Author(s):

B. Caner ◽

E. Atalar ◽

A. Karanfil ◽

L. Tokgözoğlu ◽

E. L. Ergün

Keyword(s):

Blood Pressure ◽

Myocardial Perfusion ◽

Systolic Blood Pressure ◽

Myocardial Perfusion Scintigraphy ◽

Stress Test ◽

Dobutamine Infusion ◽

Perfusion Scintigraphy ◽

Tilt Table ◽

Study Results ◽

Group A

Summary Aim: Dobutamine as a predominant beta-1 agonist increases heart rate and myocardial contractility and at sufficient high doses, it also increases systolic blood pressure. This study was undertaken to describe instances of paradoxical hypotension during dobutamine infusion for TI-201 myocardial perfusion SPECT study and the relationship between scintigraphic findings and hypotension occurred during dobutamine infusion. Methods: In 201 consecutive patients unable to perform adequate exercise, dobutamine TI-201 myocardial SPECT was performed. Dobutamine was infused starting from 10 μg/kg/min increasing to 40 μg/kg/min. Paradoxical hypotension was defined as a decrease in systolic blood pressure ≥ 20 mmHg compared with baseline study. Results: Paradoxical hypotension was observed in 40 patients (Group A) out of 201 (19.9%) while no significant change in systolic blood pressure was detected in the remaining 161 patients (Group B). Mean maximum fall in systolic blood pressure was 39 ± 18 mmHg (range: 20-90). In 33 of 40 patients (83%) with paradoxical hypotension, scintigraphy was normal compared to 131 (81%) of the remaining 161 patients. In patients of Group A, angiography, echocardiography and tilt table tests were performed in 13, 11 and 6 patients respectively. Nine of 13 angiographic evaluations (69%), 10 of 11 echocardiographic evaluations (91%), all of the tilt table tests were normal. Additionally, all of the patients of Group A were clinically followed up at least 6 months after the myocardial perfusion scintigraphy. None of the patients had a cardiac event except one patient during the follow-up period. Conclusion: Paradoxical hypotension during dobutamine infusion for myocardial scintigraphy is not an uncommon finding and up to 19.9% patients may develop such hypotension. To maximize test safety, precautions should be taken during dobutamine myocardial stress test, since remarkable decrease in systolic blood pressure may occur. Unlike hypotension occurring with exercise test, hypotension response to dobutamine is not always a marker for coronary artery disease.

Download Full-text