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Division of Cardiology, Minamiuwa Ehime Prefectural Hospital; Minamiuewa-gun; Division of Cardiology and Division of Radiology, Ehime National Hospital, Onsen-gun, Ehime, Japan
Correspondence: For correspondence or reprints contact: Kouki Watanabe, MD, Division of Cardiology, Minamiuwa Ehime Prefectural Hospital, Jouhen-cyo, Minamiuwa-gun, Ehime, 798-41, Japan.
ABSTRACT
We examined whether 201Tl myocardial scintigraphy with intravenous infusion of adenosine triphosphate (ATP) can be substituted for dipyridamole (DIP) in the diagnosis of coronary artery disease (CAD). Methods: The coronary flow reserve (CFR) during intravenous infusion of ATP (0.10–0.20 mg/kg/min) was compared with that during intravenous infusion of DIP (0.56 mg/kg) using a Doppler flow wire in 19 subjects with normal coronary arteries. The highest CFR level was found in the ATP dose range of 0.16–0.20 mg/kg/min. The CFR at the ATP dose of 0.16 mg/kg/min was significantly higher than that during DIP infusion (4.2 versus 3.6) (p < 0.01), for which reason we adopted this dose of ATP. Accordingly, 201Tl SPECT in 140 patients with suspected CAD was performed after infusion of 0.16 mg/kg/min of ATP in 70 of them and 0.56 mg/kg of DIP in the 70 others. Results: ATP stress 201Tl SPECT showed no significant difference in sensitivity and accuracy from DIP stress 201Tl SPECT (87.0% versus 82.9, and 87.1% versus 78.6, respectively). Adverse effects occurred at higher frequency when ATP was used,but they were mild and disappeared rapidly after administration was stopped. Conclusion: ATP stress 201Tl SPECT is accurate and safe. The optimal ATP regimen for this purpose is considered to be a 5-min infusion at 0.16 mg/kg/min. However, our data in CAD patients suggest that ATP stress 201Tl SPECT is equivalent to DIP stress 201Tl SPECT in the detection of CAD.
Key Words: thallium-201 • adenosine triphosphate • dipyridamole • coronary artery disease • coronary flow reserve
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