Assessment of adenosine, arbutamine and dobutamine as pharmacological stress agents during Tc-99m-tetrofosmin SPECT imaging: a randomized study

We evaluated the use of adenosine, dobutamine and arbutamine with Tc-99m-te trofosmin myocardial perfusion imaging. Forty patients under investigation for suspected coronary artery disease were recruited. Each had a resting sc an and two separate stress scans on different days, in randomized cross-ove r study. Resultant images were blindly reported in 13 segments per scan as normal, reversible or fixed defects. A score was given (0-3) for segmental defect severity. Haemodynamic responses were as expected for each agent. Su bjective side effect scores did not differ overall between agents. Adenosin e caused a significantly higher incidence of abnormal taste (54%) than dobu tamine and arbutamine (both 23%) and a lower incidence of palpitations (25% vs 69% and 54%, respectively), all P < 0.05. Arbutamine caused significant ly more chest pain than adenosine (77% vs 46%) though less flushing (35% vs 68%), both P<0.5. Comparison of the results obtained showed highly signifi cant levels of segmental agreement for visual and sen-Li-quantitative analy sis between adenosine and arbutamine, kappa value and correlation coefficie nt of 0.78 and 0.86, respectively, dobutamine and adenosine 0.69 and 0.78, and arbutamine and dobutamine 0.75 and 0.78, all P<0.0001. Adenosine, arbut amine and dobutamine differ in their haemodynamic response and side effect profile but provide highly comparable results during Tc-99m SPECT imaging. ((C) 2001 Lippincott Williams & Wilkins).