HEMODYNAMIC EFFECTS OF SIMPLE HAND PUMP EXERCISE SUPPLEMENTATION TO ADENOSINE STRESS PROTOCOL ON TC-99M SESTAMIBI IMAGING
Keywords:
Adenosine, Sestamibi, Hemodynamic changes, Hand pump exercise, ElectrocardiogramAbstract
Objective: To find out the effect of simple hand pump exercise on standard adenosine stress technetium-99m sestamibi myocardial perfusion imaging in patients who were unable to perform on treadmill or bicycle ergometer.
Study Design: Prospective non-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 June 2014 to 31st Dec 2015.
Material and Methods: One hundred and forty-five consecutive patients who were physically unfit to perform exercise by their lower extremities were included in this study. These patients underwent adenosine Tc-99m sestamibi cardiac single photon emission computed tomography with exercise supplementation (AdenEx) protocol. Hemodynamic changes, electrocardiographic and scan findings were studied. These results were compared with a control group (Aden) which included 136 patients who underwent adenosine infusion alone.
Results: The mean age of AdenEx patients was 55 ± 13 years and that of the Aden group 57 ± 12 years. In AdenEx group heart rate increased to 37% as compared to 12% increase in Aden group. In AdenEx there was not a single incidence of hypotension as compared to Aden group where significant fall in systolic and diastolic blood pressure (millimeter of Mercury) from 140 ± 22 to 108±12 and 74 ± 16 to 50 ± 14 respectively. Chest discomfort, dyspnea, headache, jaw, neck and gastrointestinal symptoms were significantly less in AdenoEx group. The AdenEx group showed higher ECG sensitivity 6% vs 34%, respectively; p = .003).
Conclusion: By addition of simple hand pump exercise during adenosine infusion prevent fall in blood pressure, significantly increases heart rate, reducing side effects and increases ECG sensitivity. This protocol is best for patients who are unable to perform exercise by utilizing their lower extremities.
