Open AccessEchocardiographic Stress Test with Adenosine Triphosphate: Optimization of the Algorithm
Author(s) -
N.J. Nelasov,
Р В Сидоров,
М. Н. Моргунов,
Н. С. Долтмурзиева,
O. Eroshenko,
E. A. Arzumanjan,
A. G. Nechaeva,
S V Shluik
Publication year - 2019
Publication title -
kardiologiâ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.159
H-Index - 16
eISSN - 2412-5660
pISSN - 0022-9040
DOI - 10.18087/cardio.2019.11.2665
Subject(s) - adenosine triphosphate , algorithm , stress (linguistics) , test (biology) , optimization algorithm , computer science , mathematical optimization , mathematics , medicine , geology , paleontology , philosophy , linguistics
Purpose . To: 1) optimize algorithm of stress echocardiography (s-Echo) with intravenous adenosine triphosphate (ATP) infusion taking into account pharmacokinetics and pharmacodynamics of ATP in human body, 2) test new algorithm in patients with coronary and other heart diseases. Materials and methods . In order to determine spectrum of factors influencing the results of stress test with ATP we inspected main scientific data bases and found 48 publications on ATP application for diagnostic purposes. Analysis of these publications allowed us to optimize algorithm of ATP s-Echo. Optimized algorithm was tested on 26 subjects, who underwent ATP 4D strain-stress-echocardiography of the left ventricle. Results and discussion . Optimized algorithm has three stages: registration of Echo data sets before, at the time of ATP infusion, and after 5 min of ATP infusion termination. Registration of Echo parameters at the second stage must begin not earlier than 3 min after the onset of ATP infusion and only in the presence of signs of coronary vasodilation. We think that the main indirect criterion of submaximal coronary vasodilation is 5 mm Hg or more decrease in systolic blood pressure (SBP), but not below SBP level of 90 mm Hg. Initial dose of ATP is 140 µg/kg/min. If after 2 min of infusion SBP do not diminish we increase the infusion rate at first to 175 and then to 210 µg/kg/min. While testing new algorithm in all cases we have achieved criteria of effective vasodilation. Mean SBP decrease was 16.4±13.7 mm Hg, heart rate increase – 12.7±8.1 bpm. In all patients we obtained interpretable 4D LV Echo data sets for visual analysis of local contractility and automatic strain analysis. Conclusion . Optimization of ATP sEcho algorithm was performed. Safety and efficacy of optimized algorythm for registration of echo data was demonstrated. New ATP infusion algorithm can also be recommended for testing with other cardiac imaging modalities in evaluation of myocardial perfusion and contractility (SPECT, CT, MRI, PET).