Hemodynamic responses and adverse effects associated with adenosine and dipyridamole pharmacologic MPI SPECT stress testing: AdenoDip study

Abstract

Objective.The aim of our study was to compare the hemodynamic response and the adverse effects associated with two coronay vasodilatators used for pharmacologic stress SPECT MPI.Material and Methods.Restropective observational study comparing the hemodynamic response and side effects of two vasodilatator pharmacologic stressors:adenosine and dyoiridamole in a group of patients who underwent pharmacologicalstress SPECT myocardial perfusion imaging,92 case match patients were included in the study during2018.One day rest –stress Tc99m sestamibi.ECGgated SPECT MPI protocol was utilized.Dipyridamole protocol was 0.56 mg/kg over 4 min,adenosine was infused 140 мg/kg/min over 6 min.All patients received the total dose od stressor.Results:There was no statistically significant diference in initial ,peak and delta heat rate between the groups (as expresses threw means),however, adenosine patients had OR 2.3[(CI1.7-3.2); p-0.000;Mantel-Haenszel OR estimate sig 0.001],for drop in HR,as compared with DIP patients.Patients in DIP group had significantly higher initial systolic BP[139 versus 131 mm HG(mean),p=0,032];but no statistically significant difference was observed in delta TA over maximal stress,as demonstrated through means,However adenosine patients had OR2[(CI1.2-3.3);p=0.002, Mantel-Haenszel OR estimate sig 0.002],to have a rice in systolic BP,as compared to DIP patients.Horizontal or down sloping ST-segment depression of > 1 mm occurred in 4,3% of patients who recived adenosine and in 10,9% of patients who recived dipyridamole(p=ns).Adverse effects occurred in 68% of the adenosine study group and in 46%of the dipyridamole group (p<0.003).Chest pain was the most common symptom with both drugs.Atrioventricular block,and /or sinus pauses > 2 sec occurred in 36 (6,5%) patients who recived adenosine but in none from the DIP group (p-ns,)Aminophylline was administered in 45 % of adenosine patients versus 70% of DIP patients (p=0.05).Conclusion.Adenosine causes slightly grater decrease in heart rate;however, there was no more pronounced vasodiltation observed.Adverse effects occurs less often with dipyridamole but, in comparasion with adenosine,are more difficult to manage and require more monitoring time as well as frequent intravenous use of aminophylline for reversal.