The impact of adjuntive adenosine infusion during exercise myocardial perfusion imaging: Results of the both exercise and adenosine stress test (BEAST) trial

Thomas A. Holly, Aaron Satran, David S. Bromet, Jennifer H. Mieres, Martin J. Frey, Michael D. Elliott, Gary V. Heller, Robert Hendel

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background. Failure to achieve an adequate heart rate limits the sensitivity of exercise myocardial perfusion imaging (MPI) for the detection of coronary artery disease. In addition, it is often not possible to discontinue medications that may blunt the heart rate response to exercise, because of conditions such as hypertension or angina. However, if pharmacologic stress testing is performed, the ability to assess functional capacity is lost. Accordingly, we developed a protocol that incorporates adenosine stress with symptom-limited exercise. Methods and results. As part of a multicenter study, 35 patients were enrolled prospectively and underwent both exercise MPI and exercise MPI with a 4-minute adenosine infusion on a separate day. Technetium 99m sestamibi was injected at or near peak exercise (exercise only) and at 2 minutes into the adenosine infusion (combined exercise and adenosine). The perfusion images were interpreted in a blinded fashion. The combined adenosine and exercise protocol was well tolerated. The summed stress scores and summed difference scores were greater in the exercise-plus-adenosine group than in the exercise-only group (10.0 vs 8.5, P = .02, and 4.9 vs 3.3, P = .002, respectively). Exercise time was slightly but significantly less with the exercise-plus-adenosine protocol (8 minutes 46 seconds vs 8 minutes 11 seconds, P = .027). Conclusion. A protocol combining 4 minutes of adenosine infusion with symptom-limited exercise was safe and well tolerated. Furthermore, this protocol resulted in a greater amount of myocardial ischemia detected on MPI while allowing for the assessment of functional capacity. A combined exercise and adenosine protocol may be a useful test for patients undergoing MPI who are unlikely to achieve an adequate chronotropic response.

Original languageEnglish
Pages (from-to)291-296
Number of pages6
JournalJournal of Nuclear Cardiology
Volume10
Issue number3
DOIs
StatePublished - May 1 2003
Externally publishedYes

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Myocardial Perfusion Imaging
Exercise Test
Adenosine
Exercise
Heart Rate
Technetium Tc 99m Sestamibi
Multicenter Studies

Keywords

  • Adenosine
  • Myocardial perfusion imaging
  • Symptom-limited exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The impact of adjuntive adenosine infusion during exercise myocardial perfusion imaging : Results of the both exercise and adenosine stress test (BEAST) trial. / Holly, Thomas A.; Satran, Aaron; Bromet, David S.; Mieres, Jennifer H.; Frey, Martin J.; Elliott, Michael D.; Heller, Gary V.; Hendel, Robert.

In: Journal of Nuclear Cardiology, Vol. 10, No. 3, 01.05.2003, p. 291-296.

Research output: Contribution to journalArticle

Holly, Thomas A. ; Satran, Aaron ; Bromet, David S. ; Mieres, Jennifer H. ; Frey, Martin J. ; Elliott, Michael D. ; Heller, Gary V. ; Hendel, Robert. / The impact of adjuntive adenosine infusion during exercise myocardial perfusion imaging : Results of the both exercise and adenosine stress test (BEAST) trial. In: Journal of Nuclear Cardiology. 2003 ; Vol. 10, No. 3. pp. 291-296.
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