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CLINICAL RESEARCH: STRESS IMAGING

Comparison of treadmill exercise versus dipyridamole stress with myocardial perfusion imaging using rubidium-82 positron emission tomography

Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Manuscript received August 20, 2004; revised manuscript received November 26, 2004, accepted January 4, 2005.

^_* Reprint requests and correspondence: Dr. Terrence D. Ruddy, University of Ottawa Heart Institute, 40 Ruskin Street (H-1 PET Centre), Ottawa, ON K1Y 4W7 Canada. (Email: truddy{at}ottawaheart.ca).

OBJECTIVES: This study assessed the feasibility of treadmill exercise rubidium-82 (⁸²Rb) positron emission tomography (PET) and compared image quality and diagnostic content with dipyridamole ⁸²Rb PET in patients referred for evaluation of coronary artery disease (CAD).

BACKGROUND: Dipyridamole stress ⁸²Rb PET myocardial perfusion imaging (MPI) is an accurate imaging modality used to diagnose CAD and determine prognosis. Although pharmacologic stress is used routinely, exercise treadmill stress may be an alternative and provide clinical information helpful to decision making, particularly for patients unwilling or unable to tolerate pharmacologic stress.

METHODS: Fifty patients (mean age, 60 ± 10 years; 47 men) underwent treadmill exercise and dipyridamole ⁸²Rb PET. Images were assessed: 1) qualitatively using a 17-segment model and a semiquantitative visual score on a five-point scale and with calculation of summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS); and 2) quantitatively with a 70% threshold for abnormal perfusion and expressed as extent of abnormal perfusion (% left ventricular).

RESULTS: Treadmill exercise was preferred by 74% of patients (37 of 50, p < 0.001). The exercise and dipyridamole ⁸²Rb PET summed scores and quantitative extent of abnormal perfusion were very similar and highly correlated. Results of Bland-Altman analysis showed no significant bias. Image quality was superior with exercise stress with greater myocardial uptake and higher target to background ratios.

CONCLUSIONS: Treadmill exercise ⁸²Rb PET is feasible and provides imaging results of similar diagnostic content and superior image quality compared with dipyridamole stress. Treadmill exercise is a reasonable alternative to pharmacologic stress with ⁸²Rb PET MPI.

Abbreviations and Acronyms   APMHR = age-predicted maximum heart rate   AV = atrioventricular   CAD = coronary artery disease   CCS = Canadian Cardiovascular Society   ECG = electrocardiography   LV = left ventricular   MPI = myocardial perfusion imaging   PET = positron emission tomography   82Rb = rubidium-82   SDS = summed difference score   SRS = summed rest score   SSS = summed stress score

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