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Effect of intravenous adenosine infusion on myocardial perfusion and function. Hemodynamic/angiographic and
J D Ogilby1, A S Iskandrian, W J Untereker
1Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
Insights
Adenosine stress testing reveals perfusion defects in most coronary artery disease (CAD) patients, but systolic function remains stable. This suggests diastolic dysfunction contributes to hemodynamic changes during adenosine infusion for CAD diagnosis.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Myocardial perfusion imaging (MPI) with adenosine or dipyridamole is standard for diagnosing coronary artery disease (CAD).
- Perfusion abnormalities may stem from differing flow responses or coronary steal phenomena.
- This study investigates the correlation between 201Tl perfusion patterns and hemodynamic/angiographic changes during intravenous adenosine infusion.
Purpose of the Study:
- To examine the relationship between 201Tl perfusion patterns and hemodynamic/angiographic changes during intravenous adenosine infusion.
- To assess the diagnostic accuracy of 201Tl MPI during adenosine stress for CAD.
- To understand the mechanisms underlying perfusion abnormalities and hemodynamic responses in CAD patients.
Main Methods:
- 33 CAD patients and 12 controls underwent simultaneous hemodynamic, coronary arteriographic, left ventriculographic, and 201Tl SPECT imaging during adenosine infusion.
- Adenosine was administered intravenously at 140 µg/kg/min for 6 minutes.
- Quantitative analysis of coronary stenosis and left ventricular function was performed.
Main Results:
- 201Tl MPI demonstrated 94% sensitivity and 100% specificity for CAD detection.
- Adenosine infusion caused significant hemodynamic changes, including increased heart rate, cardiac output, and pulmonary capillary wedge pressure, with decreased systemic vascular resistance and blood pressure.
- A disparity was observed between perfusion defects (41% of segments) and preserved or improved regional wall motion (8% of segments) in CAD patients.
Conclusions:
- Adenosine stress testing reveals a discrepancy between myocardial perfusion defects and preserved global/regional systolic function in CAD patients.
- Diastolic left ventricular dysfunction is likely responsible for the observed increase in pulmonary capillary wedge pressure.
- 201Tl MPI during adenosine infusion is a sensitive and specific method for diagnosing CAD, highlighting potential diastolic dysfunction.
Background:
Myocardial perfusion imaging during adenosine-induced hyperemia with dipyridamole or adenosine is an accepted method to diagnose coronary artery disease (CAD) and risk assessment. The mechanism of perfusion abnormality may be caused by disparate flow responses or coronary steal. This study examined the relation between 201Tl perfusion pattern and hemodynamic/angiographic changes during intravenous adenosine infusion.
Methods And Results:
Patients with suspected CAD underwent sequential hemodynamic, coronary arteriographic, and left ventriculographic studies simultaneously with 201Tl imaging during adenosine infusion (140 micrograms.kg-1.min-1 for 6 minutes). There were 33 patients with CAD and 12 patients without CAD. The 201Tl images (using single-photon emission computed tomography) were abnormal in 31 patients with CAD (sensitivity, 94%) and normal in the patients without CAD (specificity, 100%). In patients with and without CAD, there were significant increases in heart rate and cardiac output (p less than 0.0001) and decreases in systemic vascular resistance and blood pressure (p less than 0.0001). There was a 77 +/- 38% increase in pulmonary capillary wedge pressure in normal subjects and a 125 +/- 83% increase in patients with CAD (p = 0.02). ST segment depression was observed in 11 patients with CAD (33%). In CAD patients, there was no change in percent diameter or area stenosis measured quantitatively during adenosine infusion. In 15 patients, contrast left ventriculography was repeated during adenosine infusion. In these patients, 201Tl perfusion defects were seen in 31 of 75 segments (41%) whereas only six of 75 segments (8%) developed regional wall motion abnormality (p less than 0.001); the remaining segments showed either no change or improved function. The left ventricular ejection fraction did not change significantly (73% versus 75%).
Conclusions:
There is a disparity between the effects of adenosine on left ventricular perfusion and function; most patients with CAD have perfusion defects whereas the global and regional systolic function remains unchanged or improves. Diastolic left ventricular dysfunction is a probable mechanism of the increase in pulmonary capillary wedge pressure.
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