Document Detail

Outcome of patients with adenosine-induced ST-segment depression but with normal perfusion on tomographic imaging.
MedLine Citation:
PMID:  17027561     Owner:  NLM     Status:  MEDLINE    
Most patients with ST depression during adenosine infusion have reversible perfusion defects by single-photon emission computed tomographic (SPECT) perfusion images. Occasionally ST depression is observed in the setting of normal perfusion images. The outcome of such patients is controversial. We identified 65 patients who underwent gated SPECT perfusion imaging with adenosine as the stress agent. These patients were selected based on the following criteria: none had previous myocardial infarction or coronary revascularization, all were in sinus rhythm, and none had left bundle branch block. The 65 patients had normal SPECT images but ischemic ST response (>or=1 mm ST depression). There were 52 women and 13 men who were 66 +/- 13 years of age. History of diabetes mellitus was present in 16 patients (25%) and hypertension in 48 patients (74%). At a mean follow-up of 24 months, there were no cardiac deaths or myocardial infarctions, and there were 6 coronary revascularization procedures (2 coronary artery bypass graftings and 4 coronary stentings of 1-vessel coronary disease). One patient died of cancer. In conclusion, patients with no previous myocardial infarction or coronary revascularization who have normal SPECT images have a benign outcome despite the presence of ST depression (0% for death or myocardial infarction and 4.6%/year for coronary revascularization). Balanced ischemia could not be a common cause for discordant perfusion and ST response.
Fadi G Hage; Eva V Dubovsky; Jaekyeong Heo; Ami E Iskandrian
Publication Detail:
Type:  Journal Article     Date:  2006-08-17
Journal Detail:
Title:  The American journal of cardiology     Volume:  98     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-09     Completed Date:  2006-11-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1009-11     Citation Subset:  AIM; IM    
The Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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MeSH Terms
Adenosine / administration & dosage,  diagnostic use*
Anti-Arrhythmia Agents / administration & dosage,  diagnostic use*
Arrhythmias, Cardiac / physiopathology
Coronary Artery Disease / diagnosis*,  mortality,  physiopathology
Exercise Test
Follow-Up Studies
Infusions, Intravenous
Myocardial Ischemia / physiopathology
Reproducibility of Results
Tomography, Emission-Computed, Single-Photon / methods*
Treatment Outcome
Ventricular Dysfunction, Left / diagnosis*,  mortality,  physiopathology
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 58-61-7/Adenosine

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