MONTREAL — Adenosine stress testing with supplemental arm pumping exercise had the same diagnostic accuracy as exercise stress testing in detecting significant coronary artery disease in a study of 302 patients.
The results validate a long-standing practice at Massachusetts General Hospital, Boston, where supplemental arm exercise with light weights—not arm exercise with squeeze balls and not a treadmill walk—has been used for a decade to prevent adenosine-related side effects during myocardial perfusion imaging.
Arm-pumping exercise is utilized in all patients who are unable to safely negotiate a treadmill, which includes many inpatients as well as elderly and arthritic patients and those with increased risk of falling because of seizure or balance disorders, Dr. Arash Kardan, of the hospital, said in an interview at the annual meeting of the American Society of Nuclear Cardiology.
Though not well studied or understood, supplemental exercise is thought to mitigate adenosine-related bradycardia and hypotension via a neurocirculatory response, he said. “It really works; it's not just a distraction for the patient.”
The study was presented in a poster at the meeting, and included 302 patients referred for clinically indicated rest-stress myocardial perfusion imaging (MPI) with technetium 99m sestamibi. Patients underwent either exercise stress testing using the standard Bruce protocol achieving 85% of maximum predicted heart rate, or received an adenosine infusion of 0.14 mg/kg per minute for 4–5 minutes in one arm and pumped a 2.5-pound weight with their opposite arm.
All patients underwent coronary angiography within 2 months of MPI. Positive MPI was defined as demonstrating a reversible defect, while positive angiography was defined as the presence of any lesion with greater than 50% stenosis. Patients with a past history of myocardial infarction or coronary bypass surgery were included for analysis. Overall, one-third of patients had prior reported coronary artery disease.
There were 158 patients in the exercise stress group, with a mean age of 63 years. The sensitivity was 91% and specificity 100%, the authors reported.
There were 144 patients in the arm exercise group, with a mean age of 68 years. Sensitivity was 84% and specificity 81%; the differences from the exercise stress group were nonsignificant. No adenosine arm tests required termination because of side effects. All exercise treadmill tests were completed as well, he said.
The hospital has performed 10,000 adenosine tests using the arm-pumping exercises, and less than 1% of tests have been terminated, Dr. Kardan said. “We've been doing this for years, and wanted to get the message out.”