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      Comparison of Adenosine and Exercise Stress Test for Quantitative Perfusion Imaging in Patients on Beta-Blocker Therapy


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          Beta-blocker therapy is used to decrease myocardial ischemia during exercise but may cause suboptimal diagnostic performance in exercise stress testing. The aim of the present study was to compare results of quantitative technetium-99-sestamibi single photon emission tomography (SPECT), following exercise stress test or pharmacological stress test with adenosine. We chose adenosine as comparison, since betablockers may not interfere with adenosine induced vasodilatation and therefore possibly may not interfere with its diagnostic performance. Sixteen patients with angiographically documented coronary disease (5 single-vessel, 6 two-vessel and 5 three-vessel disease), who were chronically treated with beta-blockers, performed SPECT imaging at rest, following bicycle exercise and following adenosine infusion in random order. The SPECT data were analyzed visually and quantitatively, using dedicated computer software (CEqual). According to both visual and quantitative SPECT analysis, adenosine was superior to show reversibility. Higher reversibility extent (50 ± 15 vs. 26 ± 12 pixels, p < 0.01) and more intense reversibility severity (110 ± 29 vs. 49 ± 23 sum of SDs, p < 0.05) were observed during adenosine than exercise. Conclusions: Less myocardial perfusion abnormalities during exercise than during adenosine stress in patients treated with beta-blockers may indicate less ischemia but also an impaired diagnostic performance. Thus adenosine stress test should be preferred to optimize the diagnostic sensitivity in patients during beta-blocker treatment.

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          Is the calcium antagonist debate having an effect on clinical practice?

          The controversies over the long-term safety of calcium antagonists have produced considerable debate in both the medical and lay press. However, there are no data on whether this debate has influenced routine clinical practice. As most drugs in the Western healthcare systems are prescribed by primary care physicians, the aim of this study was to explore the perceptions of primary care clinicians with regard to their prescribing of calcium antagonists. Semistructured interviews of primary care physicians were performed in four countries, the Netherlands, Germany, Spain, and the United States. These interviews investigated the levels of awareness of primary care physicians about the recent calcium antagonist debate, and whether the debate had influenced their personal prescribing practice. Physicians were also asked if they considered the duration of calcium antagonist action to be clinically important. The results indicated that, despite the recent controversy over the safety of calcium antagonists, primary care physicians were largely unaware of the debate and had made no significant alterations to their routine practice. Although 15% cited potential nonspecified side effects, only 14% recalled a specific connection between the use of calcium antagonists and adverse cardiac events or higher mortality. Knowledge of adverse risks was significantly greater among physicians in the United States than among physicians in the other 3 countries. Finally, 90% of respondents were aware of the differences in duration of action of various calcium antagonists; of these, 90% felt that this had clinical significance.
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            A comparison of adenosine and arbutamine for myocardial perfusion imaging

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              Is quantification necessary in SPECT perfusion imaging?


                Author and article information

                S. Karger AG
                June 2001
                28 June 2001
                : 95
                : 2
                : 112-118
                Departments of aClinical Physiology, Hospital Physics and Internal Medicine, and bDivision of Cardiology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
                47356 Cardiology 2001;95:112–118
                © 2001 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 4, Tables: 4, References: 36, Pages: 7
                Diagnostic Cardiology


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