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Suggested Cardiolite® One-Day Stress/Rest1-3
An alternative, one-day protocol places the stress portion first, which may fit better into some existing imaging schedules.1 Results with the one-day stress/rest protocol are comparable to those with the one-day rest/stress protocol.1
Stress Portion
- Patient undergoes exercise or pharmacologic stress
- Inject with 10 mCi of Cardiolite® at peak exercise stress, or at the specified time if a pharmacologic agent is used
- After Cardiolite® injection, patient needs to continue (exercise) stress for an additional 1–3 minutes1
- Begin exercise stress scan 30–60 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
- Upon completion of the stress imaging and review for quality approval, it is recommended that the patient wait 3–4 hours before receiving rest injection
— The 3- to 4-hour wait time is determined to optimize perfusion image acquisition of the heart at rest
Rest Portion
- Inject with 25–30 mCi of Cardiolite®
- Administer rest injections 60–90 minutes prior to imaging
— The delay time should be sufficient to minimize overlap of hepatobiliary uptake with myocardial activity2
*“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 Stress/Rest Algorithm
Stress Portion
Rest Portion
One-Day Stress/Rest Imaging Sequence:
- Imaging after stress injection with a technetium agent is much more flexible than with Tl-201 due to different redistribution characteristics of the agents2
- Image acquisition can be repeated if there is significant patient motion or instrument malfunction3
- Waiting at least 15 minutes postinjection to scan the patients should not degrade the images due to increased respiratory movements or upward creep phenomenon2*
- A study completed by Heo et al showed greater reversibility of perfusion defects and better contrast between abnormal and normal areas in using the rest/stress sequence over the stress/rest sequence5†
- Rest image is not considered a true rest image, but rather a post-exercise rest image. There are no clinical studies to validate how long after the stress study the rest study should be started. The general recommendation is to wait 3–4 hours after the exercise study is complete1
*From “Updated Imaging Guidelines for Nuclear Cardiology Procedures: Part I” by the American Society of Nuclear Cardiology (ASNC) as published in 2001 in the Journal of Nuclear Cardiology.2
†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
Indications and Usage: 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:
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