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Adenosine Technetium-99m-Methoxy Isobutyl Isonitrile Myocardial Tomography in Patients with Coronary Artery Disease: Comparison with Exercise

Departments of Nuclear Medicine and Internal Medicine, University Federico II and National Cancer Institute, Napoli, Italy
Institute of Nuclear Medicine, University College and Middlesex School of Medicine, London, UK

Correspondence: For correspondence and reprints contact: Alberto Cuocolo, MD, Via Posillipo 66, 80123 Napoli, Italy.

ABSTRACT

We compared the results of adenosine and bicycle exercise ^99mTc-methoxy isobutyl isonitrile (MIBI) myocardial SPECT in 22 patients (18 males and 4 females, mean age 51 ± 11 yr) with angiographically documented coronary artery disease (CAD). Methods: All patients were submitted on separate days to three intravenous injections of ^99mTc-MIBI (20 mCi); one at rest, one during exercise and one during adenosine (140 µg/kg per min for 6 min with injection of ^99mTc-MIBI at 4 min). A total of 484 myocardial segments were quantitatively analyzed. Results: Adenosine induced a significant increase of heart rate (94 ± 16 bpm at peak versus 70 ± l3 bpm at rest, p < 0.01). Systolic and diastolic blood pressure were not significantly different after adenosine infusion compared to rest. In all segments, a significant relationship between exercise and adenosine ^99mTc-MIBI uptake was observed (r = 0.90, p < 0.0001). Concordance between the two studies for identification of perfusion status was observed in 438 (90%) of the 484 segments (kappa value of 0.81). Agreement on localization of the perfusion defect to a specific vascular territory was 92%. Conclusion: Despite different hemodynamic effects, adenosine and exercise ^99mTc-MIBI SPECT imaging provide similar information in the diagnosis and localization of CAD.

Key Words: myocardial perfusion • adenosine infusion • technetium-99m-methoxy isobutyl isonitrile

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