Document Detail


Role of adenosine in pathogenesis of syndrome X: assessment with coronary hemodynamic measurements and thallium-201 myocardial single-photon emission computed tomography.
MedLine Citation:
PMID:  8837565     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study was performed 1) to examine the role of adenosine in the pathogenesis of syndrome X in patients with this syndrome and abnormal results on myocardial scintigrams during exercise, and 2) to determine the susceptibility to myocardial ischemia in this subset of patients with syndrome X. BACKGROUND: A role for adenosine in the pathogenesis of syndrome X has recently been postulated, but there are few clinical data supporting this hypothesis. METHODS: Exercise thallium-201 myocardial scintigraphy after intravenous administration of aminophylline, an adenosine receptor blocking agent, or saline solution and adenosine thallium-201 scintigraphy were performed in 26 patients with syndrome X. Hemodynamic variables during exercise and perfusion defect size after aminophylline and saline infusions were compared. At cardiac catheterization, coronary hemodynamic variables during separate infusions of adenosine and doubutamine were also examined and were compared among patients with abnormal or normal scintigrams and 10 control subjects. RESULTS: Perfusion abnormalities on exercise-thallium-201 scintigraphy occurred in 14 of 26 patients with syndrome X. Intravenous infusion of aminophylline suppressed the scintigraphic perfusion defect and prolonged the time to 1-mm ST segment depression in patients with syndrome X with abnormal exercise scintigrams. Intravenous infusion of adenosine induced a perfusion defect in the same myocardial area where the perfusion defect was observed at exercise in 7 of the 14 patients with syndrome X. At cardiac catheterization, patients with syndrome X with abnormal exercise scintigrams had lower coronary flow reserve and a greater frequency of myocardial lactate production and ST segment depression in response to the infusions of adenosine and doubtamine than did the other two groups. During adenosine infusion, great cardiac vein blood flow and oxygen content were significantly increased and myocardial oxygen consumption and lactate extraction were significantly reduced from baseline without a significant increase in rate-pressure product in this subset of patients with syndrome X. CONCLUSIONS: Patients with syndrome X with abnormal exercise scintigrams have high susceptibility to myocardial ischemia during exercise or pharmacologic stress tests, probably owing to reduced coronary flow reserve. A heterogeneous response to endogenous adenosine may contribute to scintigraphic perfusion abnormalities and myocardial ischemia during exercise in this subset of patients with syndrome X.
Authors:
Y Inobe; K Kugiyama; E Morita; H Kawano; K Okumura; S Tomiguchi; A Tsuji; A Kojima; M Takahashi; H Yasue
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  28     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1996-11-06     Completed Date:  1996-11-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  890-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Kumamoto University School of Medicine, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / physiology*
Adult
Aged
Dobutamine / diagnostic use
Exercise Test
Female
Hemodynamics / drug effects
Humans
Lactic Acid / blood
Male
Microvascular Angina / physiopathology*,  radionuclide imaging
Middle Aged
Oxygen Consumption
Thallium Radioisotopes / diagnostic use*
Tomography, Emission-Computed, Single-Photon*
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes; 34368-04-2/Dobutamine; 50-21-5/Lactic Acid; 58-61-7/Adenosine

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