Document Detail


A flow-limiting stenosis is the major determinant of exercise-induced myocardial stunning in patients with coronary artery disease.
MedLine Citation:
PMID:  20350507     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although stress-induced myocardial stunning often develops after exercise testing, determinants of this phenomenon have not been evaluated. METHODS AND RESULTS: Thirty-one patients with 1-vessel coronary artery disease, limited to the left anterior descending artery (LAD), were evaluated by quantitative coronary angiography (QCA) and intracoronary pressure measurements to calculate fractional flow reserve (FFR). In addition, electrocardiogram-gated technetium-99m sestamibi myocardial imaging was acquired >30 min after exercise and 4 h later to assess the development of stunning. Exercise-induced myocardial stunning was observed in 11 patients (35%). In patients with myocardial stunning, a summed stress score (17.3+/-7.1 vs. 8.1+/-6.2, p<0.001), summed difference score (10.3+/-4.1 vs. 2.7+/-1.9, p<0.0001), and wall motion difference score (4.8+/-2.8 vs. 0.9+/-1.1, p<0.0001) were greater than in those without, while diameter stenosis calculated by QCA (55.1+/-17.3% vs. 29.8+/-17.3%, p<0.0001) was greater and FFR reduced significantly (0.54+/-0.13 vs. 0.83+/-0.06, p<0.0001). Of note, 4 out of 21 patients (19%) with <50% LAD stenosis developed myocardial stunning, whereas only one patient with FFR of 0.64 or greater showed stunning. The best cut-off value was determined as 0.64 for FFR and 46% for QCA, providing 91% sensitivity and 100% specificity for FFR (chi-square=57.2), but 91% sensitivity and 80% specificity for diameter stenoses measured by QCA (chi-square=17.8). CONCLUSIONS: The major determinant for exercise-induced myocardial stunning was a severe flow-limiting coronary stenosis, which was more important than anatomical evaluation based on luminal narrowing alone.
Authors:
Hirokazu Tanaka; Taishiro Chikamori; Nobuhiro Tanaka; Satoshi Hida; Naohisa Shindo; Yuko Igarashi; Akira Yamashina
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Publication Detail:
Type:  Journal Article     Date:  2010-01-29
Journal Detail:
Title:  Journal of cardiology     Volume:  55     ISSN:  0914-5087     ISO Abbreviation:  J Cardiol     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804703     Medline TA:  J Cardiol     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  337-44     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. htanaka7@tokyo-med.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Coronary Angiography
Coronary Artery Disease / complications*
Coronary Stenosis / complications*,  physiopathology
Exercise Test*
Heart / radionuclide imaging
Humans
Male
Middle Aged
Myocardial Stunning / etiology*
Radiopharmaceuticals / diagnostic use
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

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