Original Article
Comparison of myocardial blood flow and flow reserve with dobutamine and dipyridamole stress using rubidium-82 positron emission tomography

https://doi.org/10.1007/s12350-020-02186-1Get rights and content

Abstract

Background

The objective of this study was to compare the hyperemic myocardial blood flow (MBF) and myocardial flow reserve (MFR) obtained with dobutamine to those of dipyridamole in patients referred for myocardial perfusion imaging (MPI) using 82Rb positron emission tomography.

Methods

One hundred and fifty-six patients who underwent a 82Rb PET MPI study with dobutamine stress were included. A matching cohort of patients who underwent a 82Rb PET MPI study with dipyridamole stress was created, accounting for sex, age, history of coronary artery disease (CAD), prior revascularization, CAD risk factors, body mass index, and MPI interpretation.

Results

Global rest MBF (median [interquartile range] 0.84 [0.64-1.00] vs 0.69 [0.59-0.85]), stress MBF (2.36 [1.73-3.08] vs 1.66 [1.25-2.06]), MFR (2.75 [2.19-3.64] vs 2.29 [1.78-2.84]), and corrected MFR (2.85 [2.14-3.64] vs 2.20 [1.65-2.75]) were all significantly higher (P < 0.0001) in the dobutamine cohort compared to the dipyridamole cohort.

Conclusion

The results of this study suggest that dobutamine produces higher MBF compared to dipyridamole in a representative population referred to nuclear cardiology laboratories.

Spanish Abstract

Antecedentes

El objetivo de este estudio fue comparar la hiperemia del flujo sanguíneo del miocardio (MBF) y la reserva de flujo miocárdico (MFR) obtenida con dobutamina y dipiridamol en pacientes remitidos para imágenes de perfusión miocárdica (MPI) usando 82Rb en tomografía por emisión de positrones.

Métodos

Fueron incluidos 156 pacientes que se sometieron a un estudio 82Rb PET MPI con estrés con dobutamina. Se creó una cohorte coincidente de pacientes que se sometieron a un estudio 82Rb PET MPI con stress por dipiridamol teniendo en cuenta el sexo, la edad, historial de enfermedad arterial coronaria (CAD), revascularización previa, factores de riesgo de CAD, índice de masa corporal y la interpretación del MPI.

Interpretación

Resultados: reposo global MBF (mediana [rango intercuartil] = 0.84 [0.64-1.00] vs 0.69 [0.59-0.85]), estrés MBF (2.36 [1.73-3.08] vs 1.66 [1.25-2.06]), MFR (2.75 [2.19-3.64] vs 2.29 [1.78-2.84]), y MFR corregido (2.85 [2.14-3.64] vs 2.20 [1.65-2.75]) todos fueron significativamente mayor (P <0,0001) en la cohorte del grupo de dobutamina en comparación con el de dipiridamol

Conclusión

Los resultados de este estudio sugieren que la dobutamina produce un MBF más alto. en comparación con dipiridamol en una población representativa referida a los departamentos de cardiología nuclear

Chinese Abstract

背景

本文旨在比较行多巴酚丁胺和双嘧达莫82Rb正电子发射断层显像术心肌灌注成像(MPI)技术测得的负荷后心肌血流(MBF)和心肌血流储备(MFR)的差异。

方法

156名患者接受多巴酚丁胺的负荷82Rb PET MPI检查。另一组匹配患者接受双嘧达莫的负荷82Rb PET MPI检查,并记录了 性别,年龄,冠心病史(CAD),血运重建史,CAD危险因素,体重指数和MPI结果。

结果

多巴酚丁胺组获得的总体静息、负荷MBF、MFR及校正后MFR均高于 双嘧达莫组(p <0.0001),结果分别为:静息MBF(中位数[四分位间距] = 0.84 [0.64-1.00] vs 0.69 [0.59- 0.85]),负荷MBF (2.36 [1.73-3.08] vs 1.66 [1.25-2.06]), MFR (2.75 [2.19-3.64] vs 2.29 [1.78-2.84]), 以及校正后的MFR (2.85 [2.14-3.64] vs 2.20 [1.65-2.75])

结论

该研究结果表明,在需要接受核心脏检查的人群中,多巴酚丁胺比双嘧达莫会得到更高的MBF。

French Abstract

Contexte

L’objectif de cette étude était de comparer le débit sanguin myocardique et la réserve de débit myocardique obtenus après administration de dobutamine par rapport à ceux obtenus après dipyridamole chez les patients référés pour imagerie de perfusion myocardique utilisant la tomographie par émission de positrons et le rubidium 82.

Méthodes

nous avons étudiés 156 patients ayant bénéficié d’ une étude de perfusion myocardique TEP 82Rb après l’administration de dobutamine et un groupe de patients similaires après épreuve d’effort pharmacologique au dipyridamole en tenant compte des éléments suivants: sexe, âge, antécédent de maladie coronaire, revascularisation antérieure, facteurs de risque, indice de masse corporelle et résultats de données de perfusion myocardique .

Résultats

La perfusion myocardique globale au repos (médiane [intervalle interquartile]) fut calculée à 0,84 [0,64-1,00] vs 0,69 [0,59-0,85]); après épreuve pharmacologique les valeurs obtenues étaient de (2,36 [1,73-3,08] vs 1,66 [1,25-2,06]). Les valeurs de réserve de débit myocardique obtenues avant (2,75 [2,19-3,64] vs 2,29 [1,78-2,84]) et après correction (2,85 [2,14-3,64] vs 2,20 [1,65-2,75]) étaient toutes significativement plus élevées (P < 0,0001) après dobutamine par rapport au dipyridamole.

Conclusion

Les résultats de cette étude suggèrent que la dobutamine produit un débit de perfusion myocardique plus élevé par rapport au dipyridamole chez les patients qui nous sont envoyés pour évaluation de leur perfusion myocardique après épreuve d’effort pharmacologique.

Introduction

Myocardial perfusion imaging (MPI) is performed routinely for the diagnosis and risk stratification of coronary artery disease (CAD).1 A typical MPI study involves two acquisitions: one at rest and one at stress. Exercise stress is usually favored as it provides supplemental information on patients’ exercise tolerance.2,3 However, a large proportion of patients are unable to complete an adequate exercise stress test and thus require pharmacological stimulation, wherein PET imaging is preferred.4 The vast majority of pharmacological stress MPI are performed using endothelial-independent smooth muscle vasodilators such as adenosine, dipyridamole, and regadenoson, which causes hyperemia via direct or indirect stimulation of the A2A receptors. Alternatively, dobutamine, a sympathetic agonist, can also be used; however, vasodilators are favored as they provide a more standardized myocardial flow increase.5 Thus, dobutamine is usually reserved for patients with contraindications to vasodilator stress agents such as allergies, severe asthma, and xanthine consumption. Reports on the effects of dobutamine versus other vasodilators on myocardial blood flow (MBF) are scarce and conflicting.6 The purpose of this study was to compare the hyperemic MBF and myocardial flow reserve (MFR) obtained with dobutamine to that of dipyridamole in patients referred for MPI using Rubidium-82 (82Rb) PET.

Section snippets

Study Population

Patients who underwent a rest-stress 82Rb PET MPI study with dobutamine stress at the University of Ottawa Heart Institute (UOHI) between 2009 and 2016 were included. All patients completed a routine questionnaire on medical history, coronary artery disease risk factors, medication, and cardiac symptoms. To compare the effects of dobutamine and dipyridamole, a matched cohort of patients who underwent a rest-stress PET MPI study was created from a large population of patients who underwent

Study Population

A total of 156 patients who underwent 82Rb PET MPI with dobutamine were included. The demographics of the dobutamine cohort and the matching dipyridamole cohort is presented in Table 1. The two cohorts were similar in sex, age, BMI, classic CAD risk factors, symptoms, and cardiac history. However, the proportion of patients with CKD was higher in the dipyridamole cohort compared to the dobutamine cohort (7.1% vs 0.6%, P = 0.0055). Both cohorts had comparable MPI findings (Table 1) with similar

Discussion

The results of this study indicate that the use of dobutamine induces on average a 20% higher increase in 82Rb PET MBF compared to dipyridamole. This appears to be in contradiction with some older studies reporting higher flow increased with vasodilators compared to dobutamine.13,14 Although some studies evaluated the effects of dobutamine on MBF with PET imaging,15, 16, 17 very few actually compared dobutamine to vasodilators.13,14,18 In a study comparing the effect of adenosine and dobutamine

New Knowledge Gained

In patients with and without CAD risk factors as well as in patients with prior MI, dobutamine produces higher stress myocardial flow compared to dipyridamole as measured by 82Rb PET.

Conclusion

The results of this study suggest that dobutamine stress produces higher MBF compared to dipyridamole in a population representative of patients referred to nuclear cardiology laboratories. When correcting for RPP, the MBF obtained with dobutamine and dipyridamole were comparable.

Acknowledgements

This study was supported in part the Advanced Imaging in Heart Failure grant (Ontario Research Fund ORF-RE-07-029). Dr Beanlands holds a Tier 1 uOttawa Research Chair in Cardiovascular Research and is supported by the uOttawa Heart Institute Vered Chair in Cardiology.

Disclosures

RSB is a consultant for- and has received Grant funding from GE Healthcare, Lantheus Medical Imaging and Jubilant DraxImage (JDI). TDR has received research Grants and other research support from GE Healthcare and Atrius

References (27)

  • Pelletier-GalarneauM et al.

    Quantification of PET myocardial blood flow

    Curr Cardiol Rep

    (2019)
  • BatemanTM et al.

    American Society of Nuclear Cardiology and Society of Nuclear Medicine and Molecular Imaging Joint Position Statement on the Clinical Indications for Myocardial Perfusion PET

    J Nucl Cardiol

    (2016)
  • CamiciPG et al.

    Coronary microvascular dysfunction: Mechanisms and functional assessment

    Nat Rev Cardiol

    (2015)

    • Cited by (7)

    View all citing articles on Scopus

    The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

    View full text
    Copyright © 2021 American Society of Nuclear Cardiology. Published by ELSEVIER INC. All rights reserved. Published by Mosby, Inc. All rights reserved.