title: Differential effects comparing exercise and pharmacologic stress on left ventricular function using gated Tc-99m sestamibi SPECT.
abstract: OBJECTIVE
  Although post-ischemic stunning has emerged as an important marker for severe coronary artery disease (CAD), differences in stress methods may have different effects on left ventricular (LV) volumes and function.
  
  
  METHODS
  To assess differential effects comparing exercise and pharmacologic stress on the LV measurements, (99m)Tc-sestamibi gated single-photon emission computed tomography (SPECT) acquired more than 30 min after stress and at rest was evaluated in 38 patients undergoing adenosine triphosphate (ATP) stress (ATP group) and 38 age-and sex-matched patients subjected to exercise stress (Ex group) among 268 patients with normal SPECT findings.
  
  
  RESULTS
  Coronary risk factors and LV volumetric measurements at baseline were similar in the two groups. Compared with volumetric measurements at rest, end-diastolic volume (EDV) increased (72 +/- 21 ml to 74 +/- 21 ml; P = 0.01), end-systolic volume increased (25 +/- 12 ml to 28 +/- 13 ml; P = 0.001), and ejection fraction (EF) decreased after stress (66% +/- 8% to 63% +/- 9%; P < 0.002) in the ATP group. In the Ex group, by contrast, no such change was observed. In addition, changes in EDV (3 +/- 6 vs. -1 +/- 5 ml; P = 0.01) and the stress-to-rest ratio of EDV (1.04 +/- 0.09 vs. 0.99 +/- 0.08; P < 0.02) after stress were greater in the ATP than in the Ex group.
  
  
  CONCLUSIONS
  Differential effects of stress methods on LV volumes persist more than 30 min after the stress. These findings should be kept in mind when interpreting post-ischemic stunning.
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Ohtaki
authors.forename: Taishiro
authors.initials: T
authors.lastname: Chikamori
authors.forename: Yuko
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hida
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Tsuguhisa
authors.initials: T
authors.lastname: Hatano
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Usui
authors.forename: Manabu
authors.initials: M
authors.lastname: Miyagi
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
mesh_terms: D000255:Adenosine Triphosphate / Q000009:adverse effects*; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D005080:Exercise Test / Q000009:adverse effects*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D019275:Radiopharmaceuticals; D012146:Rest; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000209:etiology / Q000503:physiopathology; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D019275:Radiopharmaceuticals; D000255:Adenosine Triphosphate; D017256:Technetium Tc 99m Sestamibi