TECHNETIUM 99M-LABELED TETROFOSMIN MYOCARDIAL TOMOGRAPHY IN PATIENTS WITH CORONARY-ARTERY DISEASE - COMPARISON BETWEEN ADENOSINE AND DYNAMIC EXERCISE STRESS-TESTING

Background. Pharmacologic coronary vasodilation with adenosine, combin ed with myocardial scintigraphy, is a useful test for the diagnosis of coronary artery disease (CAD) in patients unable to exercise. It has been demonstrated recently that exercise Tc-99m-labeled tetrofosmin ca rdiac imaging can be used for the detection of CAD. However, no data a re available comparing Tc-99m-labeled tetrofosmin adenosine and exerci se tests in the same patients. Methods and Results. The results of ade nosine and exercise Tc-99m-labeled tetrofosmin myocardial tomography w ere compared in 41 patients (37 men and four women; mean age 53 +/- 8 years) with suspected or known CAD who underwent coronary angiography, All patients were submitted, on separate days, to three injections of Tc-99m-labeled tetrofosmin (740 MBq intravenously): one at rest, one during bicycle exercise, and one during adenosine infusion (140 mu g/k g/min for 6 minutes with injection of Tc-99m-labeled tetrofosmin at 4 minutes). A total of 902 myocardial segments were analyzed quantitativ ely. One patient had normal coronary vessels, 19 patients had single-v essel CAD, 12 patients had two-vessel CAD, and nine patients had three -vessel CAD (>50% coronary stenosis) on coronary angiography. Adenosin e induced a significant increase in heart rate (88 +/- 16 beats/min at peak vs 72 +/- 11 beats/min at rest; p < 0.01). Systolic and diastoli c blood pressure was not significantly different after adenosine infus ion compared with rest, Double product was 22931 +/- 7039 at peak exer cise and 11229 +/- 3413 after adenosine (p < 0.01). Agreement on the p resence of abnormal single-photon emission computed tomography by aden osine and exercise was 100% by quantitative analysis, In all segments a significant relationship between exercise and adenosine Tc-99m-99m-l abeled tetrofosmin uptake was observed (r = 0.90; p < 0.001). Segmenta l agreement for regional Tc-99m-labeled tetrofosmin uptake score betwe en exercise and adenosine was observed in 737 (82%) of the 902 segment s (kappa value of 0.66). Concordance between the two studies for ident ification of perfusion status was observed in 809 (90%) of the segment s (kappa value of 0.80). Sensitivity and specificity for detection of stenosed vessels were not different for dynamic exercise stress testin g and adenosine Tc-99m-labeled tetrofosmin cardiac tomography. Conclus ions. Despite different hemodynamic effects, adenosine and dynamic exe rcise Tc-99m-labeled tetrofosmin single-photon emission computed tomog raphic imaging provides similar information in the diagnosis and local ization of CAD.