IMPACT AND OUTCOME OF MAXIMUM BICYCLE ERGOMETER EXERCISE ON ADENOSINE TC-99M SESTAMIBI MYOCARDIAL PERFUSION IMAGING IN CORONARY ARTERY DISEASE

Abstract

Objective: To determine the effects of combining maximum physical stress with adenosine infusion by using bicycle ergometer in sestamibi myocardial perfusion imaging and its impact on adenosine induced adverse effects, image quality, detection of ischemia and patient’s compliances.

Study Design: Prospective randomized controlled trial.

Place and Duration of Study: Department of Nuclear Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases; Rawalpindi: Pakistan from 1st July 2014 to 31st Oct 2015.

Material and Methods: Total study population eight hundred and twenty-eight patients age ranging from twenty-six to eighty-four years included four hundred fifty males and three hundred seventy-eight females. In three hundred and eight patients exercise was contraindicated due to physical or technical reason so they were included in adenosine only group while remaining five hundred and twenty patients were included in adenosine exercise group. These patients underwent resting first adenosine Tc-99m sestamibi gated cardiac single photon emission computed tomography with or without exercise supplementation protocols.

Results: The stress induced heart rate, systolic blood pressure and pulse pressure in adenoEx and adeno groups were 126.6 ± 19.0 vs 89.6 ± 15.2 p<.0001; 160.0 ± 20.4 vs 127.0 ± 21.2 p<.0001 and 75 ± 19.5 vs 50 ± 17.2 p<.0001 respectively. In adenoEx group the ischemic ST-segment depression occurred more often than with adeno alone group (40% vs 12%; p=0.006). The combined incidence of ischemic chest pain or ST depression (or
both) was also higher 48% vs 24%; p=0.015) with adenoEx than with adeno. Other effects like atypical chest pain, shortness of breath, flushing and one or more adverse effects were more common in adeno group. The heart to lung, heart to liver and heart to splanchnic uptake ratios were higher in AdenEx group as compared to the Adeno group.

Conclusion: Physical stress with adenosine Tc-99m sestamibi myocardial perfusion imaging not only reduces adenosine induced side effects but also enhances image quality, and reduces artifacts. Maximum bearable stress should be combined with adenosine stress myocardial perfusion studies whenever indicated and possible.