Elsevier

Journal of Nuclear Cardiology

Volume 14, Issue 3, May–June 2007, Pages 415-416
Journal of Nuclear Cardiology

ASNC clinical update
Adenosine stress protocols for myocardial perfusion imaging

https://doi.org/10.1016/j.nuclcard.2007.04.005Get rights and content

Section snippets

Issues

About 1 million patients undergo adenosine stress myocardial perfusion imaging each year. Some publications have used reduced lengths of adenosine infusion at variance with the current American Society of Nuclear Cardiology (ASNC) standards. Some nuclear laboratory directors are using or are considering use of the abbreviated adenosine protocols. Also, the US Food and Drug Administration has approved the use of adenosine with thallium. However, the use of adenosine with technetium 99m sestamibi

Background

A review of several large multicenter, prospective, blinded studies comparing adenosine (by a continuous, 6-minute infusion of 140 μg · kg−1 · min−1) with exercise thallium 201 single photon emission computed tomography (in a crossover fashion) has confirmed the safety of adenosine imaging and demonstrated a high degree of diagnostic agreement between these two stress modalities. Several other studies have also demonstrated the efficiency and tolerability of the adenosine infusion at 140 μg · kg−1 · min

Summary

Although there are no large randomized, blinded, prospective trials comparing 3- or 4-minute protocols with the 6-minute adenosine infusion protocol, there has been a history of clinical use of a 4-minute protocol with favorable results.

Kinetic data for adenosine define that the minimum time to injection of tracer should be 2 minutes to provide adequate time to achieve maximal vasodilation, and that the maximal vasodilation should continue for 2 minutes to ensure adequate uptake for both

Recommendations

ASNC continues to recommend the 6-minute infusion protocol for adenosine stress myocardial perfusion imaging as defined in the imaging guidelines.17

The 4-minute adenosine protocol is a reasonable alternative based on the known kinetics of adenosine, the established blood clearance of radiotracers, and the presently published patient series that show comparable sensitivities. In this protocol we recommend injection of tracer at the 2-minute mark, allowing 2 minutes for circulation time.

References (18)

There are more references available in the full text version of this article.

Cited by (26)

  • Safety and efficacy of intracoronary sodium nitroprusside for the assessment of coronary fractional flow reserve

    2018, Indian Heart Journal
    Citation Excerpt :

    The former produces very short lasting hyperemia leading to inaccurate results and may be associated with severe ventricular arrythmias.4,8,9 The latter requires a central venous access or a large bore peripheral vein, higher doses of the drug, and may lead to frequent unpleasant systemic side effects, which limits its use, especially in patients with reactive airway disease and advanced conduction disorders.10–13 Sodium nitroprusside is a potent vasodilator which has no effect on myocardial contractility, nonvascular smooth muscles,14–16 and has been extensively used during the non-reflow phenomenon complicating percutaneous coronary angioplasty.17,18

  • Renal function and risk stratification of diabetic and nondiabetic patients undergoing evaluation for coronary artery disease

    2010, JACC: Cardiovascular Imaging
    Citation Excerpt :

    The standard protocol includes 6 min of adenosine infusion; concern remains about suboptimal vasodilatation with a shorter duration of adenosine infusion. Although there are no randomized trials comparing 4-min versus 6-min adenosine infusion, a consensus statement from the American Society of Nuclear Cardiology agrees that “a shorter-duration adenosine infusion, lasting 4 min, has been found to be equally effective for the detection of CAD compared with the 6-min infusion” (42). Additionally, there could have been possible selection bias of sending patients with DM and CKD or CKD alone to stress imaging.

  • Current Advances in Vasodilator Pharmacological Stress Perfusion Imaging

    2009, Seminars in Nuclear Medicine
    Citation Excerpt :

    Adenosine is infused at the rate of a 140 μg/kg/min for 6 minutes, although an abbreviated 4-minute protocol has been found to be comparable with the standard 6-minute infusion.2

  • Cardiac Positron Emission Tomography: Current Clinical Practice

    2009, Cardiology Clinics
    Citation Excerpt :

    With the short physical T1/2 of the PET tracers applied in clinical practice (13NH3 and 82Rb) exercise imaging is not performed in most PET imaging facilities. Maximal coronary flow is therefore usually obtained either by the use of pharmacologic vasodilator agents (adenosine, dipyridamole, and adenosine triphosphate) or inotropic agents (ie, dobutamine).4,24 Patient preparation is important.

  • Sixth Annual Mario S. Verani, MD Memorial Lecture: Cardiovascular imaging-Added value or added cost?

    2008, Journal of Nuclear Cardiology
    Citation Excerpt :

    Rather than outcome measures, quality might be assessed by structural and process measures (Figure 5): measures of laboratory structure, such as equipment, staff training, laboratory protocols, and credentialing of physicians, and measures of laboratory process, such as image acquisition, image interpretation, and clarity and timeliness of reporting.44,45 The leadership of the American Society of Nuclear Cardiology has been at the forefront of this movement and has had the vision to develop position statements on credentialing, training of physicians and laboratory personnel, laboratory standards, quality assurance, and reporting.46-50 More importantly, one might measure patient selection, as this is a key variable that will impact directly on subsequent clinical management, downstream testing procedures, and costs.45,46

View all citing articles on Scopus

Prepared by the American Society of Nuclear Cardiology Quality Assurance Subcommittee for Laboratory Quality, Benjamin D. McCallister, Jr, MD, Chair.

Reviewed by members of the American Society of Nuclear Cardiology Quality Assurance Committee: Edward P. Ficaro, PhD, Chair; Olakunle O. Akinboboye, MBBS, MPH, MBA, Pamela S. Appledorn, CNMT, NCT, Elias H. Botvinick, MD, Floyd W. Burke, MD, Ji Chen, PhD, Frank P. DiFilippo, PhD, David K. Glover, PhD, Richard A. Goldstein, MD, MBA, Darcy L. Green Conaway, MD, Gabriel B. Grossman, MD, PhD, Christopher L. Hansen, MD, Robert C. Hendel, MD, Milena J. Henzlova, MD, Howard C. Lewin, MD, John J. Mahmarian, MD, Haresh Majmundar, CNMT, RT(N), Rupa Mehta, MD, Vahini V. Naidoo, MD, Robert A. Quaife, MD, Joseph G. Rajendran, MD, Patty Reames, CNMT, RT[R], NCT, Vincent J. B. Robinson, MD, Raymond R. Russell III, MD, PhD, Cesar A. Santana, MD, PhD, Albert J. Sinusas, MD, Massimiliano Szulc, PhD, E. Lindsey Tauxe, CNMT, MEd, Peter L. Tilkemeier, MD, Aseem Vashist, MD, R. Parker Ward, MD, Yvonne J. Weaver, MD, and David G. Wolinsky, MD.

Approved by the American Society of Nuclear Cardiology Board of Directors, March 2, 2007.

Reprint requests: American Society of Nuclear Cardiology, 4550 Montgomery Ave, Suite 780 North, Bethesda, MD 20814

View full text