Asnc Imaging Guidelines
ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

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Exercise Stress Test

Exercise testing has been used for more than 60 years for diagnostic purposes in symptomatic patients [including patients with acute chest pain without ischemia by electrocardiogram (ECG) and serum markers] and for prognosis and risk stratification in patients with known coronary artery disease (CAD), such as history of myocardial infarction or documented CAD by coronary angiography or computed tomography angiography and in those with high risk for the presence of CAD, such as patients with

Pharmacologic Vasodilator Stress

There are currently three coronary vasodilator agents available: dipyridamole, adenosine, and regadenoson. Adenosine and its analog regadenoson work by producing stimulation of A2A receptors. Dipyridamole inhibits the phosphodiesterase enzymes that break down cAMP and inhibits the cellular reuptake of endogenous adenosine, thereby indirectly acting as an adenosine agonist. Methylxanthines (e.g., caffeine, theophylline, and theobromine) are competitive inhibitors of adenosine receptors that

Pharmacologic Synthetic Catecholamine Stress

There is one synthetic catecholamine stress agent available: dobutamine. This agent works by stimulating the β receptor, resulting in an increase in heart rate, BP, and myocardial contractility similar to exercise.

Obesity

The correct dose for the obese and morbidly obese patient is unclear. It is customary to use a weight-based dose of IV dipyridamole, IV adenosine, and IV dobutamine up to the weight of 250 lbs as the upper limit.

Left Bundle Branch Block, Ventricular Pacing, Ventricular Pre-excitation (WPW Syndrome)

Pharmacologic stress with coronary vasodilators (not IV dobutamine) is the preferred stress modality with above rest ECG patterns, both for safety (inability to monitor for ischemia) and diagnostic reasons (e.g., the presence of septal perfusion defects, not always related to

Radiotracers and Protocols

There are a variety of different protocols currently used for SPECT myocardial perfusion imaging. Table 5 contains information about these protocols: the radiopharmaceuticals used, their activities [millicuries, (mCi) or megabecquerels (MBq)], and their radiation effective doses. Figures 6 to 10 provide additional information regarding the timing of stress, injections, and imaging for each protocol. Gated imaging is recommended where feasible, at least during post-stress imaging.

The protocol

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References (147)

  • ParkerMW et al.

    A strategy of symptom-limited exercise with regadenoson-as-needed for stress myocardial perfusion imaging: A randomized controlled trial

    J Nucl Cardiol

    (2013)
  • RossMI et al.

    Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The Both Exercise and Regadenoson Stress Test (BERST) trial

    J Nucl Cardiol

    (2013)
  • ThompsonRC et al.

    Regadenoson pharmacologic stress for myocardial perfusion imaging: A three-way comparison between regadenoson administered at peak exercise, during walk recovery, or no-exercise

    J Nucl Cardiol

    (2013)
  • LetteJ et al.

    Safety of dipyridamole testing in 73,806 patients: The multicenter dipyridamole safety study

    J Nucl Cardiol

    (1995)
  • Candell-RieraJ et al.

    Simultaneous dipyridamole/maximal subjective exercise with 99mtc-mibi SPECT: Improved diagnostic yield in coronary artery disease

    J Am Coll Cardiol

    (1997)
  • CasalePN et al.

    Simultaneous low level treadmill exercise and intravenous dipyridamole stress thallium imaging

    Am J Cardiol

    (1988)
  • VitolaJV et al.

    Exercise supplementation to dipyridamole prevents hypotension, improves electrocardiogram sensitivity, and increases heart-to-liver activity ratio on tc-99m sestamibi imaging

    J Nucl Cardiol

    (2001)
  • HaysJT et al.

    Dobutamine thallium-201 tomography for evaluating patients with suspected coronary artery disease unable to undergo exercise or vasodilator pharmacologic stress testing

    J Am Coll Cardiol

    (1993)
  • JohnstonDL et al.

    Pulmonary function monitoring during adenosine myocardial perfusion scintigraphy in patients with chronic obstructive pulmonary disease

    Mayo Clin Proc

    (1999)
  • ReyesE et al.

    Side effect profile and tolerability of adenosine myocardial perfusion scintigraphy in patients with mild asthma or chronic obstructive pulmonary disease

    J Nucl Cardiol

    (2007)
  • LeakerBR et al.

    Safety of regadenoson, an adenosine A2A receptor agonist for myocardial perfusion imaging, in mild asthma and moderate asthma patients: A randomized, double-blind, placebo-controlled trial

    J Nucl Cardiol

    (2008)
  • ThomasGS et al.

    Safety of regadenoson, a selective adenosine A2A agonist, in patients with chronic obstructive pulmonary disease: A randomized, double-blind, placebo-controlled trial (RegCOPD trial)

    J Nucl Cardiol

    (2008)
  • PrennerBM et al.

    A randomized, double-blind, placebo-controlled study assessing the safety and tolerability of regadenoson in subjects with asthma or chronic obstructive pulmonary disease

    J Nucl Cardiol

    (2012)
  • AljaroudiW et al.

    Safety of regadenoson in patients with end-stage liver disease

    J Nucl Cardiol

    (2011)
  • AnanthasubramaniamK et al.

    A randomized, double-blind, placebo-controlled study of the safety and tolerance of regadenoson in subjects with stage 3 or 4 chronic kidney disease

    J Nucl Cardiol

    (2012)
  • DoukkyR et al.

    Morales Demori R. The safety and tolerability of regadenoson in patients with end-stage renal disease: The first prospective evaluation

    J Nucl Cardiol

    (2013)
  • LaigholdS et al.

    Initial clinical experience with a selective A2A receptor agonist, regadenoson, in a patient with end-stage renal disease on hemodialysis

    J Nucl Cardiol

    (2009)
  • PalaniG et al.

    Safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic kidney disease patients not on hemodialysis

    J Nucl Cardiol

    (2011)
  • AvakianSD et al.

    SPECT dipyridamole scintigraphy for detecting coronary artery disease in patients with isolated severe aortic stenosis

    Int J Cardiol

    (2001)
  • KupariM et al.

    Exclusion of coronary artery disease by exercise thallium-201 tomography in patients with aortic valve stenosis

    Am J Cardiol

    (1992)
  • PatsilinakosSP et al.

    Adenosine stress myocardial perfusion tomographic imaging in patients with significant aortic stenosis

    J Nucl Cardiol

    (2004)
  • SamuelsB et al.

    Adenosine pharmacologic stress myocardial perfusion tomographic imaging in patients with significant aortic stenosis. Diagnostic efficacy and comparison of clinical, hemodynamic and electrocardiographic variables with 100 age-matched control subjects

    J Am Coll Cardiol

    (1995)
  • CremerPC et al.

    Stress positron emission tomography is safe and can guide coronary revascularization in high-risk patients being considered for transcatheter aortic valve replacement

    J Nucl Cardiol

    (2014)
  • LentineKL et al.

    Cardiac disease evaluation and management among kidney and liver transplantation candidates: A scientific statement from the American Heart Association and the American College of Cardiology Foundation

    J Am Coll Cardiol

    (2012)
  • GieddKN et al.

    Sinus arrest during adenosine stress testing in liver transplant recipients with graft failure: Three case reports and a review of the literature

    J Nucl Cardiol

    (2005)
  • LapeyreAC et al.

    The impact of caffeine on vasodilator stress perfusion studies

    J Nucl Cardiol

    (2004)
  • AqelRA et al.

    Effect of caffeine administered intravenously on intracoronary-administered adenosine-induced coronary hemodynamics in patients with coronary artery disease

    Am J Cardiol

    (2004)
  • HageFG et al.

    The effect of caffeine on adenosine myocardial perfusion imaging: Time to reassess?

    J Nucl Cardiol

    (2012)
  • ReyesE et al.

    High-dose adenosine overcomes the attenuation of myocardial perfusion reserve caused by caffeine

    J Am Coll Cardiol

    (2008)
  • LeeJC et al.

    Effect of caffeine on adenosine-induced reversible perfusion defects assessed by automated analysis

    J Nucl Cardiol

    (2012)
  • ZoghbiGJ et al.

    Effect of caffeine on ischemia detection by adenosine single-photon emission computed tomography perfusion imaging

    J Am Coll Cardiol

    (2006)
  • GaemperliO et al.

    Interaction of caffeine with regadenoson-induced hyperemic myocardial blood flow as measured by positron emission tomography: A randomized, double-blind, placebo-controlled crossover trial

    J Am Coll Cardiol

    (2008)
  • DepueyEG et al.

    Patient-centered imaging

    J Nucl Cardiol

    (2012)
  • EinsteinAJ et al.

    Patient-centered imaging: Shared decision making for cardiac imaging procedures with exposure to ionizing radiation

    J Am Coll Cardiol

    (2014)
  • DePueyEG et al.

    A comparison of the image quality of full-time myocardial perfusion SPECT vs wide beam reconstruction half-time and half-dose SPECT

    J Nucl Cardiol

    (2011)
  • DuvallWL et al.

    Reduced isotope dose and imaging time with a high-efficiency CZT SPECT camera

    J Nucl Cardiol

    (2011)
  • MachacJ et al.

    Positron emission tomography myocardial perfusion and glucose metabolism imaging

    J Nucl Cardiol

    (2006)
  • HansenCL et al.

    Myocardial perfusion and function: Single photon emission computed tomography

    J Nucl Cardiol

    (2007)
  • ChangSM et al.

    Normal stress-only versus standard stress/rest myocardial perfusion imaging: Similar patient mortality with reduced radiation exposure

    J Am Coll Cardiol

    (2010)
  • DuvallWL et al.

    The prognosis of a normal stress-only tc-99m myocardial perfusion imaging study

    J Nucl Cardiol

    (2010)
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    An erratum to this article can be found at http://dx.doi.org/10.1007/s12350-016-0463-x.

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