Related Experiment Video
Updated: Aug 2, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Myocardial perfusion and angiographic correlations in patients with ST-segment elevation during dobutamine stress
1Section of Cardiology, Baylor College of Medicine, and The Methodist Hospital, Houston, TX 77030, USA.
Insights
Dobutamine-induced ST-segment elevation in patients undergoing myocardial perfusion imaging often indicates significant coronary artery disease and impaired heart function. It can signify severe ischemia or coexisting scarring and ischemia.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Limited data exists on the relationship between dobutamine-induced ST-segment elevation and coronary angiography findings.
- Understanding these correlates is crucial for accurate diagnosis and risk stratification.
Purpose of the Study:
- To investigate the angiographic and myocardial perfusion characteristics associated with dobutamine-induced ST-segment elevation.
Main Methods:
- Retrospective analysis of 39 patients with dobutamine-induced ST-segment elevation and recent coronary angiography.
- Assessment of baseline characteristics, coronary artery disease extent, Q waves, ischemic burden, and perfusion imaging findings.
Main Results:
- Most patients had prior myocardial infarction, multivessel disease, and abnormal perfusion imaging.
- Good agreement was observed between ST-segment elevation sites and ischemia or significant coronary stenosis locations.
- Ischemia predominance was higher in patients without Q waves.
Conclusions:
- Dobutamine-induced ST-segment elevation is linked to reduced left ventricular ejection fraction, frequent multivessel disease, and abnormal perfusion scans.
- In patients with Q waves, ST-segment elevation suggests both myocardial scarring and ischemia.
- In patients without Q waves, ST-segment elevation typically indicates severe ischemia.
Background:
There is scanty information on the angiographic and myocardial perfusion correlates of dobutamine-induced ST-segment elevation.
Methods And Results:
We studied 39 patients who exhibited ST-segment elevation during dobutamine perfusion tomography and had recent coronary angiography performed (ie, within 3 months of the dobutamine study). Baseline characteristics, extent of coronary artery disease, relationship of Q waves to ST-segment elevation, ischemic burden, and angiographic findings were assessed. Twenty-nine patients (74%) had prior myocardial infarction, and 77% had abnormal Q waves at baseline. Ninety-three percent of patients had abnormal perfusion imaging. Eighty percent of patients had multivessel coronary artery disease. The left ventricular ejection fraction by contrast ventriculography was 35% +/- 7% (mean +/- SD), the perfusion defect size was 32% +/- 15%, and 73% of patients had some degree of myocardial ischemia. A predominance of ischemia (>50% reversibility) occurred in 38% of patients with Q waves and in 70% of those without Q waves. There was also good agreement between the site of ST-segment elevation and the site of ischemia by perfusion imaging (79%) and between the site of ST-segment elevation and the location of the vessel with significant coronary stenosis (95%).
Conclusions:
Patients with dobutamine-induced ST-segment elevation have a depressed left ventricular ejection fraction, a high frequency of multivessel disease, and markedly abnormal myocardial perfusion tomography. In patients with ST-segment elevation and abnormal Q waves, substantial scarring and superimposed ischemia coexist, whereas in patients without Q waves, ST-segment elevation usually denotes severe ischemia.
