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Comparison of exercise, dipyridamole, and adenosine by use of technetium 99m sestamibi tomographic imaging

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Pharmacologic stress has been shown in animal studies to induce high degrees of myocardial hyperemia. At these levels of myocardial blood flow, the myocardial uptake of technetium 99m sestamibi may plateau and may affect the diagnostic accuracy. This study compared the effects of myocardial hyperemia induced by exercise, dipyridamole, and adenosine on99mTc sestamibi tomographic imaging in normal subjects and patients with ischemic coronary artery disease.

Methods and Results

Twenty subjects (group I, 10 normal subjects; group II, 10 patients with known coronary artery disease) underwent99mTc sestamibi tomographic imaging after rest, exercise, dipyridamole infusion, and adenosine infusions on separate occasions. Total and background-corrected myocardial counts of the resulting images were calculated. Visual and computer-generated quantitative myocardial perfusion defect analysis was performed in subjects in group II. For subjects in both groups I and II, there were no significant differences in the background-corrected myocardial counts obtained with exercise, dipyridamole, and adenosine stress. There were no significant differences in the myocardial perfusion defects obtained after the three different modes of stress, including percentage defect size, stress deficit percentage, percentage of ischemia, count deficit index, and defect nadir.


The myocardial uptake of99mTc sestamibi in normal subjects and patients with coronary artery disease is comparable after exercise, dipyridamole, and adenosine stress. In addition, the defect sizes and intensities with99mTc sestamibi after all forms of stress were equivalent. Thus99mTc sestamibi, in combination with either adenosine or dipyridamole infusions, provides imaging data equivalent to those with exercise and may be considered an alternative in patients unable to undergo adequate exercise.

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  1. 1.

    Bailey IF, Griffith LSC, Rouleau J, Strauss HW, Pitt B. Thallium-201 myocardial perfusion imaging at rest and during exercise: comparative sensitivity to electrocardiography in coronary artery disease. Circulation 1977;55:79–87.

  2. 2.

    Botvinick EH, Tardash MR, Shames DM, Parmley WW. Thallium-201 myocardial perfusion scintigraphy for the clinical clarification of normal, abnormal and equivocal electrocardiographic stress tests. Am J Cardiol 1978;41:43–51.

  3. 3.

    Kiat H, Maddahi J, Roy LT, Friedman J, Resser K, Berman DS. Comparison of technetium-99m methoxy isobutyl isonitrile with thallium-201 for evaluation of coronary artery disease by planar and tomographic methods. Am Heart J 1989;117:1–11.

  4. 4.

    Ritchie JL, Zaret BL, Strauss HW, et al. Myocardial imaging with thallium-201: a multicenter study in patients with angina pectoris or acute myocardial infarction. Am J Cardiol 1978;42:345–50.

  5. 5.

    Iskandrian AS, Heo J, Kong B, Lyons E. Effect of exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients. J Am Coll Cardiol 1989;14:1477–86.

  6. 6.

    Esquivel L, Pollack SG, Beller GA, Gibson RS, Watson DD, Kaul S. Effect of the degree of effort on the sensitivity of the exercise thallium-201 stress test in symptomatic coronary artery disease. Am J Cardiol 1987;63:160–5.

  7. 7.

    Verzijlbergen JF, Vermeersch PHMJ, Laarman G-J, Ascopp CAPL. Inadequate exercise leads to suboptimal imaging: thallium-201 myocardial perfusion imaging after dipyridamole combined with low-level exercise unmasks ischemia in symptomatic patients with nondiagnostic thallium-201 scans who exercise submaximally. J Nucl Med 1991;32:2071–8.

  8. 8.

    Travin MI, Emaus SP, Korr KS, Sadaniantz A, Heller GV. Detection of coronary artery disease as assessed by electrocardiogram or thallium-201 imaging: impact of achieved heart rate during exercise testing. Am J Noninvas Cardiol 1991;5:40–6.

  9. 9.

    Albro PC, Gould KL, Westcott RJ, Hamilton GW, Ritchie JL, Williams DL. Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilation, III: clinical trial. Am J Cardiol 1978;42:751–60.

  10. 10.

    Leppo JA, Boucher CA, Okada RD, Newell JB, Strauss HW, Pohost GM. Serial thallium-201 myocardial imaging after dipyridamole infusion: diagnostic utility in detecting coronary stenoses and relationship to regional wall motion. Circulation 1982;66:649–57.

  11. 11.

    Leppo JA, O’Brien J, Rothendler JA, Gretchell JD, Lee VW. Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction. N Engl J Med 1984;310:1014–8.

  12. 12.

    Verani MS, Mahmarian JJ, Hixson JB, Boyce TM, Staudacher RA. Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise. Circulation 1990;82:80–7.

  13. 13.

    Beller GA. Pharmacologic stress imaging. JAMA 1991;265:633–8.

  14. 14.

    Wackers FJ. Adenosine or dipyridamole: which is preferred for myocardial perfusion imaging? J Am Coll Cardiol 1991;27:1295–6.

  15. 15.

    Okada RD, Glover D, Gaffney T, Williams S. Myocardial kinetics of technetium-99m-hexakis-2-methoxy-2-methylpropyl-isonitrile. Circulation 1988;77:491–8.

  16. 16.

    Beller GA, Sinusas AJ. Experimental studies of the physiologic properties of technetium-99m isonitriles. Am J Cardiol 1990;66:5E-8E.

  17. 17.

    Glover DK, Okada RD. Myocardial kinetics of Tc-MIBI in canine myocardium after dipyridamole. Circulation 1990;81:628–36.

  18. 18.

    Leppo JA, Meerdink DJ. Comparison of myocardial uptake of a technetium-labeled isonitrile analogue and thallium. Circ Res 1989;65:632–9.

  19. 19.

    Wilson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD. Effects of adenosine on human coronary arterial circulation. Circulation 1990;82:1595–606.

  20. 20.

    Rossen JD, Quillen JE, Lopez AG, Stenberg RG, Talman CL, Winniford MD. Comparison of coronary vasodilation with intravenous dipyridamole and adenosine. J Am Coll Cardiol 1991;18:485–91.

  21. 21.

    Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 1979;300:1350–8.

  22. 22.

    Ellestadt MH. Stress testing: principles and practice. 3rd ed. Philadelphia: FA Davis, 1986:116–7.

  23. 23.

    Hecht HS, Shaw RE, Bruce T, Myler RK. Silent ischemia: evaluation by exercise and redistribution tomographic thallium-201 myocardial imaging. J Am Coll Cardiol 1989;14:895–900.

  24. 24.

    Fleiss JL. The design and analysis of clinical experiments. New York: Wiley, 1986:220–40.

  25. 25.

    Klocke FJ. Measurements of coronary flow reserve: defining pathophysiology versus making decisions about patient care. Circulation 1987;76:1183–9.

  26. 26.

    Chan SY, Brunken RC, Czernin J, et al. Comparison of maximal myocardial blood flow during adenosine infusion with that of intravenous dipyridamole in normal men. J Am Coll Cardiol 1992;20:979–85.

  27. 27.

    Gupta NC, Esterbrooke DJ, Hilleman DE, Mohiuddin SM. Comparison of adenosine and exercise thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. J Am Coll Cardiol 1992;19:248–57.

  28. 28.

    Siffring PA, Gupta NC, Mohiuddin SM, et al. Myocardial update and clearance of T1–201 in healthy subjects: comparison of adenosine-induced hyperemia and exercise stress. Radiology 1989;173:769–74.

  29. 29.

    Alazraki N, Coralli R, Galt J, Holkar R, Tarcan Y. Comparative myocardial count density in stress versus adenosine thallium-201 SPECT studies [Abstract]. J Nucl Med 1990;31:837A.

  30. 30.

    Lee J, Chae SC, Lee K, Heo J, Iskandrian AS. Comparison of thallium kinetics in normal subjects during exercise, adenosine, dipyridamole, and dobutamine stress [Abstract]. J Am Coll Cardiol 1993;21:207A.

  31. 31.

    Primeau M, Taillefer R, Essiambre R, Lambert R, Honor G. Technetium-99m sestamibi myocardial perfusion imaging: comparison between treadmill, dipyridamole and transesophageal atrial pacing “stress” tests in normal subjects. Eur J Nucl Med 1991;18:247–51.

  32. 32.

    Cuocolo A, Santomauro M, Pace L, et al. Comparison between exercise and transesophageal atrial pacing in patients with coronary artery disease: technetium-99m methoxy isonitrile simultaneous evaluation of ventricular function and myocardial perfusion. Eur J Nucl Med 1992;19:119–24.

  33. 33.

    Parodi O, Marcassa C, Casucci R, et al. Accuracy and safety of technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile (sestamibi) myocardial scintigraphy with high dose dipyridamole test in patients with effort angina pectoris: a multicenter study. J Am Coll Cardiol 1991;18:1439–44.

  34. 34.

    Iskandrian AS. Dipyridamole sesta MIBI myocardial imaging. Am J Cardiol 1991;68:674–5.

  35. 35.

    Santos-Ocampo CD, Herman SD, McClellan JR, Garber CE, Cloutier DJ, Heller GV. Prognostic significance of dipyridamole tc-99m sestamibi SPECT imaging for the evaluation of ischemic heart disease [Abstract]. J Am Coll Cardiol 1993;21:90A.

  36. 36.

    Stratmann HG, Tamesis BR, Younis LT, et al. Prognostic value of dipyridamole technetium-99m sestamibi myocardial imaging in > 300 consecutive patients with stable chest pain [Abstract]. J Am Coll Cardiol 1993;21:68A.

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Author information

Correspondence to Gary V. Heller.

Additional information

This study was conducted during Dr. Herman’s tenure as a research fellow of the American Heart Association, Rhode Island Affiliate.

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Santos-Ocampo, C.D., Herman, S.D., Travin, M.I. et al. Comparison of exercise, dipyridamole, and adenosine by use of technetium 99m sestamibi tomographic imaging. J Nucl Cardiol 1, 57–64 (1994). https://doi.org/10.1007/BF02940012

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Key Words

  • sestamibi imaging
  • pharmacologic stress
  • exercise
  • adenosine
  • dipyridamole