Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality.

Abstract

BACKGROUND:

Combining low-level treadmill exercise with adenosine infusion may result in fewer bradyarrhythmic complications by increasing sympathetic tone and may improve myocardial perfusion image quality by decreasing background activity.

METHODS:

Patients referred for outpatient pharmacologic stress myocardial perfusion imaging performed simultaneous treadmill exercise (mean 2.2 metabolic equivalents) throughout 6-minute adenosine infusion (adenosine-exercise n = 507). Patients unable to exercise and those with left bundle branch block received adenosine infusion alone (adenosine-nonexercise n = 286). Adverse reaction data were collected on all patients and compared by sex. Background-to-target activity was calculated in a blinded fashion on 200 randomly selected patients.

RESULTS:

During the period from April 1996 to December 1998, 507 patients (64%) underwent adenosine-exercise testing, whereas 286 (36%) underwent adenosine-nonexercise testing. Hypotensive and arrhythmic (atrioventricular block, sinus bradycardia, and new onset atrial fibrillation or flutter) adverse reactions occurred less often during adenosine-exercise than during adenosine-nonexercise. Neither death nor myocardial infarction occurred in either group. In the adenosine-exercise group, 2.8% of patients experienced an adverse reaction versus 5.6% of the adenosine-nonexercise group (P = .04). The reduction in adverse reactions occurred in both men and women, although women had significantly more adverse reactions than men (5.7% vs 1.8%, P = .004). Liver/heart and gut/heart ratios were lower in the adenosine-exercise group (1.05+/-0.42 vs. 1.21+/-0.55 , P = .01; 0.61+/-0.21 vs. 0.69+/-0.24, P = .03, respectively).

CONCLUSIONS:

Compared with adenosine infusion alone, combining low-level treadmill exercise with adenosine in outpatients is safe, better tolerated, and improves image quality. Women were more likely to experience adverse reactions than men.

• Authors: G S Thomas, N V Prill, H Majmundar, R R Fabrizi, J J Thomas, C Hayashida, S Kothapalli, J L Payne, M M Payne, M I Miyamoto
• Journal: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology (J Nucl Cardiol) 2000 Sep-Oct Vol. 7 Issue 5 Pg. 439-46 ISSN: 1071-3581 [Print] United States
• PMID: 11083192 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Radiopharmaceuticals
• Thallium Radioisotopes
• Technetium Tc 99m Sestamibi
• Adenosine

Topics

• Adenosine (administration & dosage, adverse effects)
• Adult
• Aged
• Aged, 80 and over
• Coronary Circulation
• Coronary Disease (diagnostic imaging)
• Exercise Test (adverse effects)
• Female
• Hemodynamics
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Radiopharmaceuticals
• Retrospective Studies
• Technetium Tc 99m Sestamibi
• Thallium Radioisotopes
• Tomography, Emission-Computed, Single-Photon