High dose adenosine stress echocardiography for noninvasive detection of coronary artery disease
A D Djordjevic-Dikic1, M C Ostojic, B D Beleslin
1University Institute for Cardiovascular Diseases, Department of Diagnostic and Catheterization Laboratories, Belgrade, Yugoslavia.
Insights
Increasing adenosine doses in stress echocardiography improves diagnostic accuracy for coronary artery disease (CAD). This enhanced protocol increases sensitivity for detecting CAD without compromising patient safety.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Background:
- Standard dose adenosine stress echocardiography has limitations in detecting milder forms of coronary artery disease (CAD).
- Pharmacologic stress testing is crucial for evaluating patients with suspected or known CAD.
Purpose of the Study:
- To evaluate the safety and diagnostic utility of higher adenosine doses in stress echocardiography for CAD detection.
- To determine if increased adenosine dosage improves sensitivity and specificity compared to standard protocols.
Main Methods:
- Adenosine stress echocardiography was performed in 58 patients with CAD.
- Doses started at 100 mcg/kg/min, increased to 140 mcg/kg/min, and further to 200 mcg/kg/min if needed.
- Coronary angiography was used as the gold standard to define significant CAD (>= 50% stenosis).
Main Results:
- Higher adenosine doses significantly increased the rate-pressure product.
- The overall sensitivity of adenosine echocardiography increased from 75% (standard dose) to 92% (high dose) (p < 0.05).
- Side effects were minimal, and specificity decreased slightly from 100% to 88% with higher doses.
Conclusions:
- Higher adenosine doses enhance the diagnostic value of stress echocardiography for CAD.
- This approach is particularly beneficial for detecting single-vessel disease.
- The improved sensitivity is achieved without significant safety concerns, with only a minor reduction in specificity.
Objectives:
The aim of this study was to assess the tolerability and incremental diagnostic value of high adenosine doses in stress echocardiography testing in patients with coronary artery disease (CAD).
Background:
In comparison with other pharmacologic stress echocardiography tests, standard dose adenosine stress has sub-optimal sensitivity for detecting milder forms of CAD.
Methods:
Adenosine stress echocardiography was performed in 58 patients using a starting dose of 100 micrograms/kg body weight per min over 3 min followed by 140 micrograms/kg per min over 4 min (standard dose). If no new wall motion abnormality appeared, the dose was increased to 200 micrograms/kg per min over 4 min (high dose). All patients underwent coronary angiography. Significant CAD was defined as > or = 50% diameter stenosis in at least one major coronary artery. Thirty-three patients had one-vessel and seven had multivessel CAD. Coronary angiographic findings were normal in 18 patients.
Results:
The high adenosine dose caused a slight but significant increase over baseline values in rate-pressure product. Limiting side effects occurred in two patients during the standard dose protocol and in one patient receiving the high dose regimen. The test was stopped in 30 patients after the standard adenosine dose regimen because of a provoked new wall motion abnormality. The sensitivity of adenosine echocardiography with the standard dose was 75% (95% confidence interval [CI] 63% to 87%). After completion of the standard dose protocol, 28 patients continued testing with the high dose adenosine protocol. The overall sensitivity of adenosine echocardiography, calculated as cumulative, increased to 92% (95% CI 84% to 100%) with the high dose (p < 0.05). The specificity of adenosine testing was 100% and 88%, respectively, with the standard and high dose regimen (p = 0.617).
Conclusions:
We believe that use of a higher than usual adenosine dose protocol for stress testing may improve the diagnostic value of adenosine echocardiography, mainly by increasing sensitivity in patients with single-vessel disease without deterioration of the safety profile and with only a mild reduction in specificity.
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