Author |
강승완(Seung Wan Kang),우언조(Eon Jo Woo),채성철(Sung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun Park),정병천(Byung Cheon Chung),최정일(Chung Il Choi),이재태(Jae Tae Lee),이규보(Kyu Bo Lee), |
Abstract |
Pharmacologic coronary vasodilation in conjunction with
myocardial scintigraphy has become an accepted
alternative to dynamic exercise testing for the
diagnosis of coronary artery disease. Although
dipyridamole has traditionally been used for this
purpose, it causes frequent side effect, which at times
can be life-threatening. Moreover, dipyridamole dose
not elicit maximal coronary vasodilation in a
substantial number of patients receiving the usual i.v.
dose. Adenosine is an endogenously produced compound
that has significant effects as a coronary vasodilator
and rapid onset action and extremely short half-life
((10 seconds). The diagnostic accuracy and safety
profile of adenosine Tc-99m-MIBI myocardial
scintigraphy were evaluated and comparison with
exercise Tc-99m-MIBI was performed. Twenty-eight
subjects underwent Tc-99m-MIBI imaging after adenosine
infusion and exercise Tc-99m-MIBI imaging. Adenosine
was infused intravenously at a dose of 0.14 mg/kg/body
weight per minute for 6 min and MIBI was injected at 3
minute. Adenosine caused an incerease in heart rate
(64±12 at baseline versus 74±16 beats/min at peak
effect, p〈0.001), a mild decrease in systolic and
diastolic blood pressure and a slightly increase in PR
interval(p; NS). Side effects were reported in 92% of
patients and were mostly mild in nature and promptly
resolved within 1 or 2 minutes of termination of
adenosine infusion. Facial flushing (53%), chest pain
(36%), mild dyspnea (39%), headache (21%), throat
discomfort (21%) were frequent symptoms. ST segment
depression(〉1mm) and second degree AV block in
electrocardiography occured in 11% of thepatients,
respectively. The overall sensitivity and specificity
for individual coronary stenoses in 16 patients
underwent coronary angiography were 88% and 95%,
respectively. The agreement ratio of segmental
perfusion between adenosine and exercise images was 92%
(Kappa index=0.82). In conclusion, Tc-99m-MIBI
myocardial perfusion scintigraphy with intravenous
adenosine is a feasible, safe and highly accurate
noninvasive technique for the detection of coronary
artery disease and results are at least comparable with
those of exercise Tc-99m-MIBI scintigraphy. |