title: Four- versus 6-minute infusion protocol for adenosine thallium-201 single photon emission computed tomography imaging.
abstract: Intravenous adenosine infusion results in immediate maximal coronary arteriolar vasodilatation. Side effects occur in most patients who receive adenosine. For these reasons, a shorter infusion for pharmacologic stress thallium-201 testing may improve patient tolerability without compromising diagnostic accuracy. In a retrospective, unblinded evaluation, we compared side effects and accuracy of a standard 6-minute adenosine infusion single photon emission computed tomography (SPECT) study with a 4-minute protocol in 730 and 621 patients, respectively. Adenosine was infused at 140 micrograms/kg/minute in both groups; thallium-201 was injected at the 3-minute mark of the 4-minute protocol and at the 4-minute mark of the 6-minute protocol. Angiographic follow-up (mean 8 days) after thallium-201 testing was available in 233 (32%) of the patients in the 6-minute protocol and in 174 (28%) of the patients in the 4-minute protocol (p not significant (NS). Side effects occurred in 90% of the patients in the 6-minute protocol and in 91% of the patients in the 4-minute protocol (p = NS). Premature termination of the infusion was required in 4% of the patients in the 6-minute protocol and 2% of the patients in the 4-minute protocol (p = 0.02). Second- or third-degree atrioventricular block was noted in 4.5% and 3.0% of the 6- and 4-minute groups, respectively (p = NS). The duration of symptoms averaged 2.9 +/- 4.4 minutes in the patients in the 6-min protocol and 2.1 +/- 1.6 minutes in the patients in the 4-minute protocol (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Mid-America Heart Institute of St. Luke's Hospital, Kansas City, MO.
authors.forename: J H
authors.initials: JH
authors.lastname: O'Keefe
authors.forename: T M
authors.initials: TM
authors.lastname: Bateman
authors.forename: L R
authors.initials: LR
authors.lastname: Handlin
authors.forename: C S
authors.initials: CS
authors.lastname: Barnhart
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013794:Thallium Radioisotopes; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes; D000241:Adenosine