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Suggested Cardiolite® One-Day Rest/Stress1,2

Using this protocol, you can complete imaging in one day. A low-dose Cardiolite® rest study is followed by a higher-dose stress study.  The higher dose Cardiolite® in the stress study overcomes the lower dose of the rest study, permitting high-quality gated SPECT imaging.1

Rest Portion

• Inject with 10 mCi of Cardiolite®
• Administer rest injection 60–90 minutes prior to imaging
  — The delay time should be sufficient to minimize overlap of hepatobiliary uptake with myocardial activity2
• Upon completion of rest imaging and review for quality approval, the patient may be prepared for stress testing. Patient should wait 1–4 hours from injection before proceeding to stress portion2
  — When the time from rest imaging to stress testing is short, ensure the dose given at stress is at least 3 times the activity of the resting dose. This will compensate for the lack of radioactivity decay of the resting dose3

Stress Portion

• Patient undergoes exercise or pharmacologic stress
• Inject with 25–30 mCi of Cardiolite® at peak (exercise) stress, or at the specified time if a pharmacologic stress agent is used
• After Cardiolite® injection, patient needs to continue (exercise) stress for an additional 1–3 minutes1
• Begin exercise stress scan 15–60 minutes after Cardiolite® injection
  —The delay time should be sufficient to prevent “upward creep” phenomenon2*
• When using pharmacologic stress, begin imaging 30–60 minutes after Cardiolite® injection4
  

  *“Upward creep” phenomenon refers to the tendency of the heart to rise in the chest cavity during and after extended exertion, possibly moving the myocardium out of optimal imaging position.

One-Day Rest/Stress Algorithm

Rest Portion




Stress Portion

One-Day Rest/Stress Imaging Sequence:

• The rest image represents a true rest perfusion image because the patient has not previously been stressed
• One-day protocol offers convenience for patients and rapid availability of results3
• Preferable when using a 1-day protocol with a short time interval (less than 2 hours) in between
  — Note that using a dose ratio less than 1:3 will necessitate increasing the time interval between the two injections3
• Rest/stress protocol provides the better image quality of the 1-day protocols and an increased ability to detect reversibility of perfusion defect(s)5*
• Using the higher contrast imaging afforded with SPECT, some investigators have further shortened the injection-to-imaging time to 15 minutes for exercise studies6†
• Image acquisition can be repeated if there is significant patient motion or instrument malfunction3
• The ejection fraction is a post-stress EF, not a stress EF, since the image acquisition occurs after the exercise

*Based on a study of 32 patients, 19 patients with CAD and 13 normal subjects, who were randomized to either the one-day rest/exercise or one-day exercise/rest protocol first; the other protocol was performed 2 to 14 days later. The study was designed to compare the two protocols in image quality, and ability to detect reversibility of the perfusion defects.5

†Based on a prospective study of 35 patients with CAD to compare 99m Tc-labeled sestamibi single-photon emission tomography imaging performed at 15 minutes and 60 minutes after the injection at stress in the detection of CAD.6

Indications and Usage:   Cardiolite®, Kit for the Preparation of Technetium Tc99m Sestamibi for Injection, is a myocardial perfusion agent that is indicated for detecting coronary artery disease by localizing myocardial ischemia (reversible defects) and infarction (non-reversible defects), in evaluating myocardial function and developing information for use in patient management decisions. Cardiolite® evaluation of myocardial ischemia can be accomplished with rest and cardiovascular stress techniques (eg, exercise or pharmacologic stress in accordance with the pharmacologic stress agent's labeling). It is usually not possible to determine the age of a myocardial infarction or to differentiate a recent myocardial infarction from ischemia. Important Safety Information: Exercise and pharmacologic stress testing should be performed only under the supervision of a qualified physician. Cardiolite® has been rarely associated with acute severe allergic events of angioedema and urticaria. The most frequently reported adverse events include headache, chest pain/angina, ST segment changes on ECG, nausea, and abnormal taste and smell. Please See Full Prescribing Information .