Original article
Comparison of myocardial blood flow and coronary flow reserve during dobutamine and adenosine stress: Implications for pharmacologic stress testing in coronary artery disease

https://doi.org/10.1016/j.nuclcard.2006.03.017Get rights and content

Background

Mechanistic differences between pharmacologic stressors may offer different clinical benefits. Therefore the effects of dobutamine and adenosine on absolute myocardial blood flow (MBF) and coronary flow reserve (CFR) were compared.

Methods and Results

We divided 36 patients (mean age, 61 ± 8 years) with coronary artery disease into 2 groups based on stenosis severity as follows: greater than 50% but less than 75% (n = 16) and greater than 75% (n = 20). In addition, 18 normal volunteers (mean age, 46 ± 7 years) served as control subjects. Groups of equal sizes received either dobutamine or adenosine. MBF at rest and peak MBF were measured by use of positron emission tomography in territories subtended by the stenosis (ischemic) and remote myocardium (remote), whereas left ventricular MBF was used in control subjects. CFR was calculated as peak MBF divided by MBF at rest. CFR was significantly greater with adenosine than with dobutamine stress in control subjects and remote CFR. Ischemic CFR was blunted to a similar degree with each stressor. Therefore adenosine achieved flow heterogeneity across all coronary stenosis severities greater than 50%. However, dobutamine achieved flow heterogeneity only in the presence of a severe coronary stenosis greater than 75% despite provoking a greater ischemic stimulus.

Conclusion

Adenosine stress demonstrated a higher sensitivity and dobutamine demonstrated a higher specificity with quantitative perfusion imaging. Therefore adenosine is superior for diagnostic perfusion imaging, whereas dobutamine is better suited in combination with visual imaging and in the functional assessment of a known coronary stenosis.

Section snippets

Methods

We recruited 36 male patients (mean age [± SD], 61 ± 8 years [range, 46-77 years]) from St Mary’s and Hammersmith Hospitals in London, United Kingdom. All described a history of chronic stable angina and demonstrated significant single-vessel coronary artery disease (CAD) during coronary angiography (stenoses >50% of luminal diameter). Exclusion criteria included a recent history (<3 months) of myocardial infarction or unstable angina, valvular heart disease, atrial fibrillation, or bundle

Results

We divided 36 patients into 2 groups based on stenosis severity: moderate (>50% but <75%) (n = 16) and severe (>75%) (n = 20). Half of the patients in each group (n = 8 with moderate stenosis and n = 10 with severe stenosis) underwent adenosine stress testing, whereas the other half underwent dobutamine stress testing. Coronary artery stenosis severity was comparable between the adenosine and dobutamine subgroups (63% ± 2% vs 69% ± 6% for those with moderate stenosis [P = not significant] and

Discussion

The principle underlying myocardial perfusion imaging relies on the identification of differential flow reserve between myocardium subtended by a stenotic coronary artery and that supplied by arteries with less severe or no disease at angiography. Our study has demonstrated progressive blunting of regional MBF and CFR in the presence of increasing coronary artery stenosis to a similar degree with both agents, although in remote myocardial segments adenosine achieved significantly greater

Acknowledgment

The authors have indicated they have no financial conflicts of interest.

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