Document Detail

ST-segment depression during adenosine infusion as a predictor of myocardial ischemia.
MedLine Citation:
PMID:  8296697     Owner:  NLM     Status:  MEDLINE    
The incidence and hemodynamic changes associated with ST-segment depression during adenosine stress testing are poorly defined. To examine this, 550 consecutive patients who underwent adenosine perfusion testing were evaluated for the development of ST-segment depression. At least 1 mm of horizontal or downsloping depression developed in 82 patients (15.9%) and was observed with similar frequency in patients with normal scans and those with only fixed defects. ST depression developed in 58 of 242 patients with reversible defects (sensitivity = 24%) and in only 24 of 275 patients without reversible defects (specificity = 91%). Its presence was highly predictive of reversible perfusion defects (predictive accuracy = 71%). Similar findings were observed in patients with and without ECG evidence of left ventricular hypertrophy. Patients with ST depression had perfusion defects in more vessel distributions, had more severe defects, and had a greater increase in heart rate during adenosine infusion. Thus ST-segment depression occurs infrequently during adenosine infusion but is specific for and predictive of myocardial ischemia, as evidenced by reversible perfusion scan defects. Patients with ST depression have more severe disease and develop faster heart rates during infusion, which could result in decreased coronary perfusion during diastole allowing for the development of myocardial ischemia.
E S Marshall; J S Raichlen; D A Tighe; J J Paul; K M Breuninger; E K Chung
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  127     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1994 Feb 
Date Detail:
Created Date:  1994-03-03     Completed Date:  1994-03-03     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  305-11     Citation Subset:  AIM; IM    
Division of Cardiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
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MeSH Terms
Adenosine / administration & dosage,  diagnostic use*
Angina Pectoris / chemically induced,  physiopathology
Blood Pressure / drug effects,  physiology
Coronary Circulation / drug effects,  physiology
Electrocardiography / drug effects*
Exercise Test* / methods
Heart Rate / drug effects,  physiology
Hypertrophy, Left Ventricular / diagnosis,  physiopathology
Infusions, Intravenous
Middle Aged
Myocardial Ischemia / diagnosis*,  physiopathology,  radionuclide imaging
Radionuclide Ventriculography
Sensitivity and Specificity
Technetium Tc 99m Sestamibi / diagnostic use
Thallium Radioisotopes / diagnostic use
Reg. No./Substance:
0/Thallium Radioisotopes; 109581-73-9/Technetium Tc 99m Sestamibi; 58-61-7/Adenosine

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