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Postischemic stunning after adenosine vasodilator stress.
Regina S Druz1, Olakunle A Akinboboye, Roger Grimson
1The Heart Center, Cardiac Imaging Research Group, Saint Francis Hospital, Roslyn, NY 11576-1348, USA. rdruzmd@aol.com
Summary
Myocardial stunning, a form of ischemia, can occur after adenosine stress testing, even in patients without coronary artery disease. This dysfunction was observed in one third of patients with severe reversible perfusion defects.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Ischemic left ventricular (LV) dysfunction is uncommon after vasodilator stress.
- Adenosine stress is generally considered less likely to induce ischemia than exercise stress.
Purpose of the Study:
- To evaluate the prevalence of LV dysfunction after adenosine stress.
- To correlate LV dysfunction with reversible perfusion defects and coronary artery disease (CAD).
Main Methods:
- 86 patients underwent adenosine dual-isotope gated single-photon emission computed tomography.
- Patients were categorized into groups based on reversible perfusion defects or absence of CAD.
- Left ventricular ejection fraction, volumes, and wall thickening were quantified using QGS.
Main Results:
- 32% of patients with extensive reversible perfusion defects (summed difference score >= 8) showed depressed post-adenosine LV ejection fraction.
- These patients also exhibited abnormal segmental wall thickening and end-systolic dilation.
- Extensive coronary artery disease was confirmed in these individuals.
Conclusions:
- Myocardial stunning, indicated by LV dysfunction, occurred in one third of patients with severe reversible perfusion defects after adenosine stress.
- This finding is consistent with exercise-induced ischemia, challenging the notion that vasodilator stress is less likely to cause ischemia.