Skip to main content
Top
Published in: Journal of Nuclear Cardiology 4/2010

01-08-2010 | Editorial

Heart rate response during vasodilator stress myocardial perfusion imaging: Mechanisms and implications

Authors: Fadi G. Hage, MD, Ami E. Iskandrian, MD, MACC

Published in: Journal of Nuclear Cardiology | Issue 4/2010

Login to get access

Excerpt

Myocardial perfusion imaging (MPI) using adenosine, dipyridamole, or regadenoson (a selective A2A receptor agonist) is an established method for detecting coronary artery disease (CAD) and risk stratification.1 In high-risk populations, as in those with diabetes mellitus (DM) or chronic kidney disease, MPI has been shown to be a powerful predictor of risk, but nevertheless, patients with normal myocardial perfusion are at higher risk than those without DM or chronic kidney disease.2,3 Thus, there continues to be a need to extract more useful prognostic data from stress MPI especially in high-risk populations. …
Literature
1.
go back to reference Iskandrian AE, Garcia EV. Nuclear cardiac imaging: Principles and applications. Oxford: Oxford University Press; 2008. Iskandrian AE, Garcia EV. Nuclear cardiac imaging: Principles and applications. Oxford: Oxford University Press; 2008.
2.
go back to reference Hakeem A, Bhatti S, Dillie KS, Cook JR, Samad Z, Roth-Cline MD, et al. Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function on cardiac death. Circulation 2008;118:2540-9.CrossRefPubMed Hakeem A, Bhatti S, Dillie KS, Cook JR, Samad Z, Roth-Cline MD, et al. Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function on cardiac death. Circulation 2008;118:2540-9.CrossRefPubMed
3.
go back to reference Giri S, Shaw LJ, Murthy DR, Travin MI, Miller DD, Hachamovitch R, et al. Impact of diabetes on the risk stratification using stress single-photon emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease. Circulation 2002;105:32-40.CrossRefPubMed Giri S, Shaw LJ, Murthy DR, Travin MI, Miller DD, Hachamovitch R, et al. Impact of diabetes on the risk stratification using stress single-photon emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease. Circulation 2002;105:32-40.CrossRefPubMed
4.
go back to reference Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. Jama 1999;281:524-9.CrossRefPubMed Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. Jama 1999;281:524-9.CrossRefPubMed
5.
go back to reference Clarke B, Conradson TB, Dixon CM, Barnes PJ. Reproducibility of heart rate changes following adenosine infusion in man. Eur J Clin Pharmacol 1988;35:309-11.CrossRefPubMed Clarke B, Conradson TB, Dixon CM, Barnes PJ. Reproducibility of heart rate changes following adenosine infusion in man. Eur J Clin Pharmacol 1988;35:309-11.CrossRefPubMed
6.
go back to reference Alberti C, Monopoli A, Casati C, Forlani A, Sala C, Nador B, et al. Mechanism and pressor relevance of the short-term cardiovascular and renin excitatory actions of the selective A2A-adenosine receptor agonists. J Cardiovasc Pharmacol 1997;30:320-4.CrossRefPubMed Alberti C, Monopoli A, Casati C, Forlani A, Sala C, Nador B, et al. Mechanism and pressor relevance of the short-term cardiovascular and renin excitatory actions of the selective A2A-adenosine receptor agonists. J Cardiovasc Pharmacol 1997;30:320-4.CrossRefPubMed
7.
go back to reference Dhalla AK, Wong MY, Wang WQ, Biaggioni I, Belardinelli L. Tachycardia caused by A2A adenosine receptor agonists is mediated by direct sympathoexcitation in awake rats. J Pharmacol Exp Ther 2006;316:695-702.CrossRefPubMed Dhalla AK, Wong MY, Wang WQ, Biaggioni I, Belardinelli L. Tachycardia caused by A2A adenosine receptor agonists is mediated by direct sympathoexcitation in awake rats. J Pharmacol Exp Ther 2006;316:695-702.CrossRefPubMed
8.
go back to reference Johnston DL, Daley JR, Hodge DO, Hopfenspirger MR, Gibbons RJ. Hemodynamic responses and adverse effects associated with adenosine and dipyridamole pharmacologic stress testing: A comparison in 2,000 patients. Mayo Clin Proc 1995;70:331-6.CrossRefPubMed Johnston DL, Daley JR, Hodge DO, Hopfenspirger MR, Gibbons RJ. Hemodynamic responses and adverse effects associated with adenosine and dipyridamole pharmacologic stress testing: A comparison in 2,000 patients. Mayo Clin Proc 1995;70:331-6.CrossRefPubMed
9.
go back to reference Hage FG, Heo J, Franks B, Belardinelli L, Blackburn B, Wang W, et al. Differences in heart rate response to adenosine and regadenoson in patients with and without diabetes mellitus. Am Heart J 2009;157:771-6.CrossRefPubMed Hage FG, Heo J, Franks B, Belardinelli L, Blackburn B, Wang W, et al. Differences in heart rate response to adenosine and regadenoson in patients with and without diabetes mellitus. Am Heart J 2009;157:771-6.CrossRefPubMed
10.
go back to reference Hage FG, Perry G, Heo J, Iskandrian AE. Blunting of the heart rate response to adenosine and regadenoson in relation to hyperglycemia and the metabolic syndrome. Am J Cardiol 2010;105:839-43.CrossRefPubMed Hage FG, Perry G, Heo J, Iskandrian AE. Blunting of the heart rate response to adenosine and regadenoson in relation to hyperglycemia and the metabolic syndrome. Am J Cardiol 2010;105:839-43.CrossRefPubMed
11.
go back to reference Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.CrossRefPubMed Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.CrossRefPubMed
12.
go back to reference Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging: Integrated ADVANCE-MPI trial results. J Am Coll Cardiol Cardiol Img 2008;1:307-16. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging: Integrated ADVANCE-MPI trial results. J Am Coll Cardiol Cardiol Img 2008;1:307-16.
13.
go back to reference Mathur S, Shah AR, Ahlberg AW, Katten DM, Heller GV. Blunted heart rate response as a predictor of cardiac death in patients undergoing vasodilator stress technetium-99m sestamibi gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2010. doi:10.1007/s12350-010-9242-2. Mathur S, Shah AR, Ahlberg AW, Katten DM, Heller GV. Blunted heart rate response as a predictor of cardiac death in patients undergoing vasodilator stress technetium-99m sestamibi gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2010. doi:10.​1007/​s12350-010-9242-2.
14.
go back to reference Maser RE, Mitchell BD, Vinik AI, Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: A meta-analysis. Diabetes Care 2003;26:1895-901.CrossRefPubMed Maser RE, Mitchell BD, Vinik AI, Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: A meta-analysis. Diabetes Care 2003;26:1895-901.CrossRefPubMed
15.
go back to reference Nagamachi S, Fujita S, Nishii R, Futami S, Tamura S, Mizuta M, et al. Prognostic value of cardiac I-123 metaiodobenzylguanidine imaging in patients with non-insulin-dependent diabetes mellitus. J Nucl Cardiol 2006;13:34-42.CrossRefPubMed Nagamachi S, Fujita S, Nishii R, Futami S, Tamura S, Mizuta M, et al. Prognostic value of cardiac I-123 metaiodobenzylguanidine imaging in patients with non-insulin-dependent diabetes mellitus. J Nucl Cardiol 2006;13:34-42.CrossRefPubMed
16.
go back to reference Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. Myocardial Iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure results of the prospective ADMIRE-HF (AdreView myocardial imaging for risk evaluation in heart failure) Study. J Am Coll Cardiol 2010;55:2212-21.CrossRefPubMed Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. Myocardial Iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure results of the prospective ADMIRE-HF (AdreView myocardial imaging for risk evaluation in heart failure) Study. J Am Coll Cardiol 2010;55:2212-21.CrossRefPubMed
17.
go back to reference Sasano T, Abraham MR, Chang KC, Ashikaga H, Mills KJ, Holt DP, et al. Abnormal sympathetic innervation of viable myocardium and the substrate of ventricular tachycardia after myocardial infarction. J Am Coll Cardiol 2008;51:2266-75.CrossRefPubMed Sasano T, Abraham MR, Chang KC, Ashikaga H, Mills KJ, Holt DP, et al. Abnormal sympathetic innervation of viable myocardium and the substrate of ventricular tachycardia after myocardial infarction. J Am Coll Cardiol 2008;51:2266-75.CrossRefPubMed
18.
go back to reference Abidov A, Hachamovitch R, Hayes SW, Ng CK, Cohen I, Friedman JD, et al. Prognostic impact of hemodynamic response to adenosine in patients older than age 55 years undergoing vasodilator stress myocardial perfusion study. Circulation 2003;107:2894-9.CrossRefPubMed Abidov A, Hachamovitch R, Hayes SW, Ng CK, Cohen I, Friedman JD, et al. Prognostic impact of hemodynamic response to adenosine in patients older than age 55 years undergoing vasodilator stress myocardial perfusion study. Circulation 2003;107:2894-9.CrossRefPubMed
19.
go back to reference Bhatheja R, Francis GS, Pothier CE, Lauer MS. Heart rate response during dipyridamole stress as a predictor of mortality in patients with normal myocardial perfusion and normal electrocardiograms. Am J Cardiol 2005;95:1159-64.CrossRefPubMed Bhatheja R, Francis GS, Pothier CE, Lauer MS. Heart rate response during dipyridamole stress as a predictor of mortality in patients with normal myocardial perfusion and normal electrocardiograms. Am J Cardiol 2005;95:1159-64.CrossRefPubMed
20.
go back to reference Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol 2009;53:2129-40.CrossRefPubMed Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol 2009;53:2129-40.CrossRefPubMed
21.
go back to reference Venkataraman R, Hage FG, Dorfman TA, Heo J, Aqel RA, de Mattos AM, et al. Relation between heart rate response to adenosine and mortality in patients with end-stage renal disease. Am J Cardiol 2009;103:1159-64.CrossRefPubMed Venkataraman R, Hage FG, Dorfman TA, Heo J, Aqel RA, de Mattos AM, et al. Relation between heart rate response to adenosine and mortality in patients with end-stage renal disease. Am J Cardiol 2009;103:1159-64.CrossRefPubMed
22.
go back to reference Piccini JP, Horton JR, Shaw LK, Al-Khatib SM, Lee KL, Iskandrian AE, et al. Single-photon emission computed tomography myocardial perfusion defects are associated with an increased risk of all-cause death, cardiovascular death, and sudden cardiac death. Circ Cardiovasc Imaging 2008;1:180-8.CrossRefPubMed Piccini JP, Horton JR, Shaw LK, Al-Khatib SM, Lee KL, Iskandrian AE, et al. Single-photon emission computed tomography myocardial perfusion defects are associated with an increased risk of all-cause death, cardiovascular death, and sudden cardiac death. Circ Cardiovasc Imaging 2008;1:180-8.CrossRefPubMed
23.
go back to reference Piccini JP, Aijing Z, Starr AZ, Horton JR, Shaw LK, Lee KL, et al. SPECT myocardial perfusion imaging and the risk of sudden cardiac death in patients with coronary disease and left ventricular ejection fraction >35%. J Am Coll Cardiol 2010 (in press). Piccini JP, Aijing Z, Starr AZ, Horton JR, Shaw LK, Lee KL, et al. SPECT myocardial perfusion imaging and the risk of sudden cardiac death in patients with coronary disease and left ventricular ejection fraction >35%. J Am Coll Cardiol 2010 (in press).
Metadata
Title
Heart rate response during vasodilator stress myocardial perfusion imaging: Mechanisms and implications
Authors
Fadi G. Hage, MD
Ami E. Iskandrian, MD, MACC
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Journal of Nuclear Cardiology / Issue 4/2010
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-010-9248-9

Other articles of this Issue 4/2010

Journal of Nuclear Cardiology 4/2010 Go to the issue