title: [The adenosine test in association with 99m-technetium sestamibi tomoscintigraphy in the diagnosis of coronary pathology].
abstract: BACKGROUND
  The exogenous adenosine is able to provoke a coronary vasodilation, which is the same as the one provoked by the papaverine and greater than the one provoked by the dipyridamole. We report our experience in using exogenous adenosine in association with technetium-99m-sestamibi tomoscintigraphy for a diagnostic test on the coronary artery disease (CAD).
  
  
  METHODS
  We considered 22 patients (18 male and 4 female, mean age 57 years) affected by angiographically demonstrated coronary artery disease (stenoses > or = 50%). Adenosine was infused at a dosage of 0.070 mg/kg/min for 3 minutes and, if well tolerated, the dosage was increased to 0.140 mg/kg/min; in the third minute of the major dosage the radioisotope was injected. The myocardial perfusion imaging at rest was evaluated on the following day.
  
  
  RESULTS
  The test was completed on 21 of the 22 patients, and 20 of the latter were subjected to the maximal dosage of the adenosine infusion. Clinically irrelevant adverse effects were observed in 20 cases; only one patient developed a II degree type 1 AV block. Angina occurred in 19 patients. Coronary angiography demonstrated significant stenosis of 35 vessels: the left anterior descending (LAD) in 14 patients, the left circumflex (LCx) in 8 and the right coronary artery (RCA) in 13. In detecting CAD, the test in our study demonstrated a sensitivity of 85% in the LAD disease, of 89% in the LCx disease and of 77% in RCA disease.
  
  
  CONCLUSIONS
  The adenosine infusion associated with technetium-99m-sestamibi tomoscintigraphy demonstrated an elevated incidence of adverse effects which are of short duration and clinically irrelevant. The method was shown to be highly sensitive in detecting the CAD.
authors.affiliation: Divisione di Cardiologia, Ospedale Generale Regionale di Bolzano.
authors.forename: A
authors.initials: A
authors.lastname: Zammarchi
authors.forename: W
authors.initials: W
authors.lastname: Pitscheider
authors.forename: R
authors.initials: R
authors.lastname: Crepaz
authors.forename: L
authors.initials: L
authors.lastname: Osele
authors.forename: D
authors.initials: D
authors.lastname: Bettini
authors.forename: C
authors.initials: C
authors.lastname: Romeo
authors.forename: E
authors.initials: E
authors.lastname: Braito
mesh_terms: D000241:Adenosine / Q000009:adverse effects; D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014664:Vasodilation / Q000187:drug effects
chemical_list: D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine
vernacular_title: Il test all'adenosina associato alla tomoscintigrafia con 99m-tecnezio-sestamibi nella diagnosi di coronaropatia.