Adenosine, a myocardial stressor and a potent vasodilator, has a short half life and few side effects. The purpose of this study was to clarify the safety and clinical usefulness of combined adenosine stress echocardiography with adenosine stress myocardial perfusion imaging for the detection of coronary artery stenosis in angina patients.

The study population consists of 78 patients who had no history of previous infarction or coronary intervention. Adenosine stress echocardiography and adenosine stress myocardial perfusion imaging were done in the same protocol several hours to one day prior to coronary angiography. Adenosine was infused under hemodynamic, ECG, and echocardiographic monitoring in dose of 0.14 mg/Kg/min, and stopped when new or worsening wall motion abnormality was developed or intolerable side effects were occurred. After three minutes of adenosine infusion, Tc-99m tetrofosmin (Myoview(R)) of 20 mCi was injected and perfusion imaging was taken 4 hours later.

For the diagnosis of significant coronary artery disease in the angina patients, the sensitivity of adenosine stress echocardiography was 750%, that of adenosine stress myocardial perfusion imaging 71.4%, and that of combined use of both methods was increased to 91.7%. The specificity was 76.1%, 92.9%, and 66.7%, respectively. Forty seven patients (60.3%) had some side effects. They were chest discomfort (29.8%), dyspnea (23.4%), headache (17.0%), chest pain (14.9%), neck discomfort, and palpitation in descending order. The study was stopped because of severe chest pain in only one case.

Although adenosine stress echocardiography and adenosine stress myocardial perfusion imaging showed similar levels of less sensitivity for diagnosis of coronary artery stenosis in the angina patients, the combined use and interpretation of both methods showed relatively higher sensitivity in comparison with either adenosine stress echocardiography or myocardial perfusion imaging alone.