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Kiko T, Yokokawa T, Masuda A, Misaka T, Yamada S, Kaneshiro T, Oikawa M, Yoshihisa A, Nakazato K, Takeishi Y. Simultaneous assessment of coronary flow reserve and left ventricular function during vasodilator stress evaluated by 13N-ammonia hybrid PET/MRI. Clin Radiol 2021; 76:472.e1-472.e9. [PMID: 33752883 DOI: 10.1016/j.crad.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
AIM To explore changes in left ventricular (LV) function and the relationship of these changes with myocardial blood flow (MBF) evaluated by 13N-ammonia hybrid positron-emission tomography (PET)/magnetic resonance imaging (MRI) during vasodilator stress in patients with suspected coronary artery disease (CAD). MATERIALS AND METHODS Fifty-two consecutive patients with suspected CAD, who underwent 13N-ammonia PET/MRI, were enrolled. Vasodilator stress was induced by intravenous injection of adenosine. MBF and coronary flow reserve (CFR) were calculated from dynamic acquisition of 13N-ammonia PET. LV function was evaluated by MRI both at rest and during vasodilator stress. An abnormal perfusion on myocardial images was defined as a summed difference score of ≥4. RESULTS MRI showed that the LV end-diastolic volume, LV end-systolic volume, and LV ejection fraction (LVEF) remained unchanged during vasodilator stress in all patients (n=52) as well as in the patients with CFR of <2 (n=27), stress MBF of <1.3 ml/g/min (n=28), abnormal myocardial perfusion (n=30), and more than one diseased vessel (n=46). In only four patients, the LVEF measured by MRI decreased by >5% during vasodilator stress. In these four patients, CFR was lower (1.57 ± 0.12 versus 2.18 ± 0.86, p<0.01) and the number of diseased vessels was higher (2.75 ± 0.50 versus 1.48 ± 0.92, p<0.01) than in patients without post-stress LV dysfunction. CONCLUSION The LV volume and systolic function evaluated by cardiac MRI remained unchanged during vasodilator stress; however, LV dysfunction during vasodilator stress may occur in patients with severe CAD.
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Affiliation(s)
- T Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan.
| | - T Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - A Masuda
- Department of Diagnostic Radiology, Tohoku University Hospital, Japan
| | - T Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - S Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - T Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - M Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - A Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - K Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Y Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
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Van Tosh A, Votaw JR, Reichek N, Palestro CJ, Nichols KJ. The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated (82)Rb PET myocardial perfusion imaging. J Nucl Cardiol 2013; 20:1060-8. [PMID: 24092270 PMCID: PMC4209719 DOI: 10.1007/s12350-013-9784-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Gated rubidium-82 ((82)Rb) positron emission tomography (PET) imaging studies are acquired both at rest and during pharmacologic stress. Stress-induced ischemic left ventricular dysfunction (LVD) can produce a significant decrease in left ventricular ejection fraction (LVEF) from rest to stress. We determined the prevalence on PET of stress LVD with reduced ejection fraction (EF) and its association with absolute global and regional coronary flow reserve (CFR), and with relative perfusion defect summed difference score (SDS). METHODS AND RESULTS We studied 205 patients with known or suspected coronary disease (120 M, 75 F, age 69 ± 13 years) who had clinically indicated rest/regadenoson stress (82)Rb PET/CT studies. Data were acquired in dynamic gated list mode. Global and 17-segment regional CFR values were computed from first-pass flow data using a 2-compartment model and factor analysis applied to auto-generated time-activity curves. Rest and stress LVEF and SDS were quantified from gated equilibrium myocardial perfusion tomograms using Emory Cardiac Toolbox software. LVD was defined as a change in LVEF of ≤-5% from rest to stress. A subgroup of 109 patients also had coronary angiography. Stress LVD developed in 32 patients (16%), with mean EF change of -10 ± 5%, vs +6 ± 7% for patients without LVD (P < .0001). EF was similar at rest in patients with and without stress LVD (57 ± 18% vs 56 ± 16%, P = .63), but lower during stress for patients with LVD (47 ± 20% vs 61 ± 16%, P = .0001). CFR was significantly lower in patients with LVD (1.61 ± 0.67 vs 2.21 ± 1.03, Wilcoxon P = .002), and correlated significantly with change in EF (r = 0.35, P < .0001), but not with SDS (r = -0.13, P = .07). The single variable most strongly associated with high risk of CAD (i.e., left main stenosis ≥50%, LAD % stenosis ≥70%, and/or 3-vessel disease) was stress EF (χ(2) = 17.3, P < .0001). There was a higher prevalence of patients with territorial CFR values ≤1.0, consistent with coronary steal, in the LVD group than in the non-LVD group (39% vs 12%, P = .001). CONCLUSIONS LVD developed in 16% of patients undergoing (82)Rb PET myocardial perfusion imaging, and was associated with multivessel coronary artery disease. There was a significant relationship between LVD and coronary blood flow during stress, with LVD corresponding to a low CFR. Territorial CFR ≤1.0 was more common in patients with LVD than those without, suggesting that coronary steal is an important pathophysiologic mechanism contributing to pharmacologic stress-induced LVD.
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Affiliation(s)
- Andrew Van Tosh
- Research Department, Division of Cardiovascular Research, St. Francis Hospital-The Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA,
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Resting cardiac 64-MDCT does not reliably detect myocardial ischemia identified by radionuclide imaging. AJR Am J Roentgenol 2013; 200:337-42. [PMID: 23345355 DOI: 10.2214/ajr.11.8171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE CT myocardial perfusion imaging is an emerging diagnostic modality that is under intensive study but not yet widely used in clinical practice. The purpose of this study is to evaluate the performance of resting 64-MDCT in revealing ischemia identified on radionuclide myocardial perfusion imaging (MPI). MATERIALS AND METHODS We retrospectively identified 35 patients (20 women and 15 men; mean age, 52 years) with myocardial ischemia found on MPI who underwent retrospectively gated CT within 90 days of MPI. Myocardial perfusion on CT was evaluated using both a visual (n = 35) and an automated (n = 34) method. For the visual method, myocardial segments were evaluated qualitatively in systole and diastole. For the automated method, subendocardial perfusion of the standard 17 American Heart Association segments was measured using a commercially available tool in both systole and diastole. Differences between systolic and diastolic perfusion were computed. RESULTS Five hundred eighty myocardial segments were evaluated, 152 of which were ischemic on MPI. Visual analysis had a sensitivity of 16% (24/152), specificity of 92% (393/428), positive predictive value of 40% (24/60), and negative predictive value of 75% (392/520) in systole, and a sensitivity of 18% (27/152), specificity of 89% (382/428), positive predictive value of 37% (27/73), and negative predictive value of 75% (382/507) in diastole, as compared with MPI. There was no significant difference in subendocardial perfusion between ischemic and nonischemic segments by the automated method. There was no significant difference in CT perfusion between patients with and without obstructive coronary artery disease on CT angiography using the visual or automated methods. CONCLUSION Resting 64-MDCT is unsuitable for clinical use in revealing ischemia seen on MPI.
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Desai D, Kozeski G, Akinboboye O. Detection of multivessel coronary artery disease: looking beyond the extent of perfusion abnormalities. J Nucl Cardiol 2009; 16:4-5. [PMID: 19152122 DOI: 10.1007/s12350-008-9036-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 11/09/2008] [Indexed: 11/27/2022]
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Nagao M, Matsuoka H, Kawakami H, Higashino H, Mochizuki T, Ohshita A, Kohno T, Shigemi S. Detection of Myocardial Ischemia Using 64-Slice MDCT. Circ J 2009; 73:905-11. [PMID: 19325193 DOI: 10.1253/circj.cj-08-0940] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michinobu Nagao
- Department of Radiology, Ehime University Graduate School of Medicine
| | | | - Hideo Kawakami
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
| | - Hiroshi Higashino
- Department of Radiology, Ehime University Graduate School of Medicine
| | | | - Akira Ohshita
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
| | - Tamami Kohno
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
| | - Susumu Shigemi
- Departments of Cardiology, Prefectural Ehime Imabari Hospital
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Quantification of myocardial perfusion by contrast-enhanced 64-MDCT: characterization of ischemic myocardium. AJR Am J Roentgenol 2008; 191:19-25. [PMID: 18562719 DOI: 10.2214/ajr.07.2929] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Assessment of hemodynamic changes in ischemic cardiac segments at rest using CT has yet to be performed. We hypothesized that variations in subendocardial perfusion during the cardiac cycle might be related to the appearances of ischemia. The purpose of this study was to investigate myocardial perfusion in ischemic segments using contrast-enhanced 64-MDCT. SUBJECTS AND METHODS We performed cardiac MDCT at rest and stress/rest (201)Tl myocardial perfusion scintigraphy (MPS) in 34 patients with suspected coronary artery disease. We reconstructed 2D long- and short-axis cardiac images in diastolic and systolic phases using raw data from coronary CT angiography. The attenuation value (in Hounsfield units) in the myocardium was used as an estimate of myocardial perfusion. We measured the subendocardial intensity of 17 segments according to the American Heart Association classification. Systolic perfusion or diastolic perfusion was calculated by dividing the subendocardial intensity at systole or diastole, respectively, for each segment by the mean value across all segments for each patient. We used stress/rest MPS to evaluate the variation in myocardial perfusion at systole and diastole for the segments diagnosed as ischemic or nonischemic. RESULTS Systolic perfusion for ischemic segments was significantly lower than that for nonischemic segments in 15 of 17 segments. The difference between systolic perfusion and diastolic perfusion in ischemic segments was significantly lower than that in nonischemic segments (14 of 17 segments). There was no significant difference in diastolic perfusion between ischemic and nonischemic segments (15 of 17 segments). CONCLUSION Our results suggest that a pattern of subendocardial hypoperfusion at systole and normal perfusion at diastole characterizes ischemic myocardium.
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Kugiyama K, Inobe Y, Ohgushi M, Morita E, Motoyama T, Ogawa H, Yasue H. Comparison of coronary hemodynamics during infusions of dobutamine and adenosine in patients with angina pectoris. JAPANESE CIRCULATION JOURNAL 1998; 62:1-6. [PMID: 9559411 DOI: 10.1253/jcj.62.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pharmacologic stress tests are used to evaluate the significance of coronary arterial stenosis, and adenosine and dobutamine are often used for this purpose. The aim of this study was to examine coronary hemodynamics in 16 patients with stable exertional angina who had organic stenosis (> 90%) in the left anterior descending coronary arteries and in 13 control subjects at baseline and during separate intravenous infusions of dobutamine (20 micrograms/kg per min [corrected]) and adenosine (140 micrograms/kg per min [corrected]). Measurements of great cardiac vein blood flow and lactate and oxygen contents in the blood from the aortic root and great cardiac vein were analyzed in patients with ischemic signs of myocardial ischemia (ST-segment depression in the precordial ECG leads and/or myocardial lactate production) during the infusions (in 11 patients during adenosine infusion and in 12 patients during dobutamine infusion) and in control subjects. Myocardial oxygen consumption during adenosine infusion did not change compared with the baseline in both groups, whereas it increased during dobutamine infusion in both groups (p < 0.01 compared with the baseline in each case). However, great cardiac vein blood flow was significantly increased compared with the baseline during both infusions in both groups (p < 0.01 compared with baseline in each case), and the oxygen contents of great cardiac vein blood, which contains effluent from the ischemic region, showed no decrease but increased significantly during both infusions in the patients in comparison with control subjects. Although the global oxygen supply was excessive, myocardial ischemia occurred during dobutamine and adenosine infusions in the patients. As myocardial oxygen consumption remained unchanged during adenosine infusion, regional myocardial flow reduction, possibly as a result of flow maldistribution, may contribute, at least partly, to adenosine-induced myocardial ischemia. An increase in myocardial oxygen consumption may be the principal cause of myocardial ischemia during dobutamine infusion, but an inappropriate flow increase in normal myocardium may occur during dobutamine-induced ischemia.
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Affiliation(s)
- K Kugiyama
- Division of Cardiology, Kumamoto University School of Medicine, Japan
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Inobe Y, Kugiyama K, Morita E, Kawano H, Okumura K, Tomiguchi S, Tsuji A, Kojima A, Takahashi M, Yasue H. Role of adenosine in pathogenesis of syndrome X: assessment with coronary hemodynamic measurements and thallium-201 myocardial single-photon emission computed tomography. J Am Coll Cardiol 1996; 28:890-6. [PMID: 8837565 DOI: 10.1016/s0735-1097(96)00271-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study was performed 1) to examine the role of adenosine in the pathogenesis of syndrome X in patients with this syndrome and abnormal results on myocardial scintigrams during exercise, and 2) to determine the susceptibility to myocardial ischemia in this subset of patients with syndrome X. BACKGROUND A role for adenosine in the pathogenesis of syndrome X has recently been postulated, but there are few clinical data supporting this hypothesis. METHODS Exercise thallium-201 myocardial scintigraphy after intravenous administration of aminophylline, an adenosine receptor blocking agent, or saline solution and adenosine thallium-201 scintigraphy were performed in 26 patients with syndrome X. Hemodynamic variables during exercise and perfusion defect size after aminophylline and saline infusions were compared. At cardiac catheterization, coronary hemodynamic variables during separate infusions of adenosine and doubutamine were also examined and were compared among patients with abnormal or normal scintigrams and 10 control subjects. RESULTS Perfusion abnormalities on exercise-thallium-201 scintigraphy occurred in 14 of 26 patients with syndrome X. Intravenous infusion of aminophylline suppressed the scintigraphic perfusion defect and prolonged the time to 1-mm ST segment depression in patients with syndrome X with abnormal exercise scintigrams. Intravenous infusion of adenosine induced a perfusion defect in the same myocardial area where the perfusion defect was observed at exercise in 7 of the 14 patients with syndrome X. At cardiac catheterization, patients with syndrome X with abnormal exercise scintigrams had lower coronary flow reserve and a greater frequency of myocardial lactate production and ST segment depression in response to the infusions of adenosine and doubtamine than did the other two groups. During adenosine infusion, great cardiac vein blood flow and oxygen content were significantly increased and myocardial oxygen consumption and lactate extraction were significantly reduced from baseline without a significant increase in rate-pressure product in this subset of patients with syndrome X. CONCLUSIONS Patients with syndrome X with abnormal exercise scintigrams have high susceptibility to myocardial ischemia during exercise or pharmacologic stress tests, probably owing to reduced coronary flow reserve. A heterogeneous response to endogenous adenosine may contribute to scintigraphic perfusion abnormalities and myocardial ischemia during exercise in this subset of patients with syndrome X.
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Affiliation(s)
- Y Inobe
- Division of Cardiology, Kumamoto University School of Medicine, Japan
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Marshall ES, Raichlen JS, Kim SM, Intenzo CM, Sawyer DT, Brody EA, Tighe DA, Park CH. Prognostic significance of ST-segment depression during adenosine perfusion imaging. Am Heart J 1995; 130:58-66. [PMID: 7611124 DOI: 10.1016/0002-8703(95)90236-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To determine the significance of ST-segment depression during adenosine perfusion imaging for predicting future cardiac events, 188 patients with interpretable electrocardiograms were assessed 1 to 3 years (mean 21.5 +/- 6.6 months) after adenosine testing. At least 1 mm of ST-segment depression was observed in 32 (17%) patients, with > or = 2 mm of ST-segment depression in 10 (5.3%). Thirty-seven cardiac events occurred during the study period: 2 cardiac deaths, 5 nonfatal myocardial infarctions, 6 admissions for unstable angina, and 24 revascularizations. Univariate predictors of events were a history of congestive heart failure, previous non-Q-wave myocardial infarction, previous coronary angioplasty, use of antianginal medication, ST-segment depression during adenosine infusion (particularly > or = 2 mm), any reversible perfusion defect, transient left ventricular cavity dilation, and the severity of perfusion defects. Multivariate analysis identified > or = 2 mm ST-segment depression as the most significant predictor of cardiac events (relative risk [RR] = 6.5; p = 0.0001). Other independent predictors of events were left ventricular dilation (RR = 3.8; p = 0.002), previous coronary angioplasty (RR = 3.3; p = 0.001), a history of non-Q-wave myocardial infarction (RR = 2.3; p = 0.01), and the presence of any reversible defect (RR = 2.0; p = 0.05). We conclude that ST-segment depression occurs uncommonly during adenosine infusion, but the presence of > or = 2 mm of ST-segment depression is an independent predictor of future cardiac events and provides information in addition to that obtained from clinical variables and the results of adenosine perfusion imaging.
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Affiliation(s)
- E S Marshall
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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Aksut SV, Pancholy S, Cassel D, Cave V, Heo J, Iskandrian AS. Results of adenosine single photon emission computed tomography thallium-201 imaging in hemodynamic nonresponders. Am Heart J 1995; 130:67-70. [PMID: 7611125 DOI: 10.1016/0002-8703(95)90237-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Systolic blood pressure typically decreases during adenosine infusion because of stimulation of A2b receptors, resulting in systemic vasodilation. This study examined the results of adenosine single photon emission computed tomography (SPECT) thallium-201 imaging in patients who did not show such a decrease in blood pressure during peak adenosine effect (nonresponders). The 102 nonresponders and 341 responders had no significant differences in age, gender, history of diabetes mellitus, hypertension, or previous myocardial infarction. The extent of coronary artery disease (CAD) by angiography was also similar. The sensitivity of SPECT thallium-201 imaging in patients with one-vessel disease was 82% in nonresponders and 84% in responders (p value not significant [NS]); in patients with multivessel disease, it was 90% in nonresponders and 94% in responders (p = NS) and for all CAD, it was 87% in non-responders and 91% in responders (p = NS). Thus lack of hemodynamic systemic response during adenosine infusion does not affect sensitivity for detecting CAD.
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Affiliation(s)
- S V Aksut
- Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104, USA
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Bullough DA, Zhang C, Montag A, Mullane KM, Young MA. Adenosine-mediated inhibition of platelet aggregation by acadesine. A novel antithrombotic mechanism in vitro and in vivo. J Clin Invest 1994; 94:1524-32. [PMID: 7929829 PMCID: PMC295300 DOI: 10.1172/jci117493] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Inhibition of platelet aggregation by acadesine was evaluated both in vitro and ex vivo in human whole blood using impedance aggregometry, as well as in vivo in a canine model of platelet-dependent cyclic coronary flow reductions. In vitro, incubation of acadesine in whole blood inhibited ADP-induced platelet aggregation by 50% at 240 +/- 60 microM. Inhibition of platelet aggregation was time dependent and was prevented by the adenosine kinase inhibitor, 5'-deoxy 5-iodotubercidin, which blocked conversion of acadesine to its 5'-monophosphate, ZMP, and by adenosine deaminase. Acadesine elevated platelet cAMP in whole blood, which was also prevented by adenosine deaminase. In contrast, acadesine had no effect on ADP-induced platelet aggregation or platelet cAMP levels in platelet-rich plasma, but inhibition of aggregation was restored when isolated erythrocytes were incubated with acadesine before reconstitution with platelet-rich plasma. Acadesine (100 mg/kg i.v.) administered to human subjects also inhibited platelet aggregation ex vivo in whole blood. In the canine Folts model of platelet thrombosis, acadesine (0.5 mg/kg per min, i.v.) abolished coronary flow reductions, and this activity was prevented by pretreatment with the adenosine receptor antagonist, 8-sulphophenyltheophylline. These results demonstrate that acadesine exhibits antiplatelet activity in vitro, ex vivo, and in vivo through an adenosine-dependent mechanism. Moreover, the in vitro studies indicate that inhibition of platelet aggregation requires the presence of erythrocytes and metabolism of acadesine to acadesine monophosphate (ZMP).
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Affiliation(s)
- D A Bullough
- Department of Cardiovascular Pharmacology, Gensia Inc., San Diego, California 92121
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Bowker TJ. Covert coronary disease and non-invasive evidence of covert myocardial ischaemia: their prevalence and implications. Int J Cardiol 1994; 45:1-7. [PMID: 7995659 DOI: 10.1016/0167-5273(94)90049-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Iskandrian AS, Verani MS, Heo J. Pharmacologic stress testing: mechanism of action, hemodynamic responses, and results in detection of coronary artery disease. J Nucl Cardiol 1994; 1:94-111. [PMID: 9420675 DOI: 10.1007/bf02940016] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pharmacologic stress testing may be used in the diagnosis of coronary artery disease and risk assessment. The stress agents may be divided into those that produce primary coronary vasodilation (dipyridamole, adenosine, or adenosine triphosphate) and those that produce secondary vasodilation as a result of increase in myocardial oxygen demand (dobutamine and arbutamine). Assessment of myocardial perfusion and function can be made by single-photon imaging, positron emission tomography, two-dimensional echocardiography, magnetic resonance imaging, and contrast angiography. For assessment of myocardial perfusion, either thallium 201-labeled or technetium-labeled perfusion imaging agents may be used. This article will focus on the mechanisms of action, hemodynamic responses, and results of pharmacologic imaging in detecting coronary artery disease. The use of pharmacologic stress testing in risk assessment will be discussed in a separate article.
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Affiliation(s)
- A S Iskandrian
- Philadelphia Heart Institute, Presbyterian Medical Center, Philadelphia, PA 19104, USA
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