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Adenosine myocardial perfusion imaging in the noninvasive diagnosis and prognosis of coronary artery disease
Author(s) -
Verani Mario S.
Publication year - 1993
Publication title -
drug development research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.582
H-Index - 60
eISSN - 1098-2299
pISSN - 0272-4391
DOI - 10.1002/ddr.430280319
Subject(s) - adenosine , medicine , vasodilation , coronary artery disease , cardiology , scintigraphy , coronary arteries , myocardial perfusion imaging , perfusion , adenosine receptor , chest pain , dipyridamole , blood flow , perfusion scanning , artery , anesthesia , receptor , agonist
Adenosine is a purine base compound which is of fundamental importance in many physiologic processes in the body, including vasodilation in most arterial vascular beds. Adenosine produces maximal or near‐maximal coronary vasodilation by interacting with the adenosine A2 receptors in the cell wall, on a dose dependent fashion. The mechanism of thallium‐201 myocardial perfusion defects induced by adenosine scintigraphy is a heterogeneity of myocardial blood flow due to a greater coronary flow increase in the normal arteries and a lesser increase in the stenotic arteries. The ultra‐short half‐life of adenosine (< 10 sec) necessitates continuous intravenous administration at a dose of 140 μg/kg/min for six min. The excellent safety record of this regimen has been demonstrated in several thousand patients in the United States. Side effects occur in most patients during adenosine infusion. Chest pain occurs often and in some cases may be due to a true coronary steal phenomenon. In the author's experience, first degree AV block occurs in approximately 10% and second or third degree AV block in approximately 4% of the patients, and are due to the negative dromotropic effect of adenosine on the AV node. On the positive side, these untoward effects are very short‐lived and typically disappear within one or two minutes after discontinuing the adenosine infusion. No serious complications or fatalities have been observed to date with this test. The cumulative experience with adenosine thallium‐201 scintigraphy indicates high sensitivity and specificity in the diagnosis of coronary artery disease. Recent data also suggest it may be an excellent technique to assess a patient's prognosis early after a myocardial infarction. Adenosine‐induced coronary vasodilation, in combination with thallium‐201 or the new technetium‐99m perfusion agents, holds great promise in the assessment of patients with coronary artery disease. © 1993 Wiley‐Liss, Inc.