| Angiographic and hemodynamic determinants of myocardial ischemia during adenosine thallium-201 scintigraphy in coronary artery disease. | |
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MedLine Citation:
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PMID: 8462147 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Myocardial ischemia attributed to coronary steal may occur in some patients receiving pharmacological coronary vasodilation. ECG ST-segment depression is a marker of myocardial ischemia in these patients, but the factors determining the presence or absence of ischemia are not well known. METHODS AND RESULTS: To examine the angiographic, hemodynamic, and scintigraphic determinants of adenosine-induced ischemic ST-segment depression in patients with coronary artery disease, we studied 65 consecutive patients (45 men and 20 women; mean age, 65 +/- 12 years) who showed reversible perfusion defects during adenosine (140 micrograms.kg-1.min-1 for 6 minutes) 201Tl single-photon emission computed tomography. Patients with prior myocardial infarction were excluded. Ischemic ST depression occurred in one third of the whole cohort (22 of 65 patients). The presence of coronary collateral vessels (p = 0.001), systolic blood pressure at baseline (p = 0.006), and adenosine-induced anginal chest pain (p = 0.011) were the only significant independent predictors of ischemic ST-segment depression by stepwise logistic regression analysis. Rate-pressure product at baseline, systolic blood pressure, heart rate, rate-pressure product, increase in heart rate, and rate-pressure product during adenosine infusion and maximal percent stenosis were variables also significantly related to ischemic ST depression by univariate analysis but were not predictive after the three primary variables were included in the regression model. Perfusion defect size, number of diseased vessels, and age did not correlate with ST-segment depression. CONCLUSIONS: The presence of collaterals, which may predispose to coronary collateral steal, is the most significant correlate of ischemic ST-segment depression during adenosine infusion. Systolic blood pressure at baseline, which may affect the myocardial oxygen supply/demand ratio and anginal chest pain induced by adenosine, are additional variables related to ischemic ST-segment depression during adenosine infusion. |
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Authors:
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S Nishimura; K T Kimball; J J Mahmarian; M S Verani |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Circulation Volume: 87 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1993 Apr |
Date Detail:
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Created Date: 1993-04-30 Completed Date: 1993-04-30 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1211-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Baylor College of Medicine, Houston, Tex. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine
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diagnostic use* Aged Collateral Circulation / physiology Coronary Angiography Coronary Circulation / physiology Coronary Disease / radionuclide imaging* Female Heart / radionuclide imaging* Hemodynamics / physiology* Humans Male Myocardial Ischemia / chemically induced*, epidemiology, physiopathology Regression Analysis Thallium Radioisotopes / diagnostic use Tomography, Emission-Computed, Single-Photon* |
| Grant Support | |
ID/Acronym/Agency:
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RR-00350/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Thallium Radioisotopes; 58-61-7/Adenosine |
| Comments/Corrections | |
Comment In:
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Circulation. 1993 Apr;87(4):1415-7
[PMID:
8462165
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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