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Quantitative relation between hemodynamic changes during intravenous adenosine infusion and the magnitude of coronary

Rakesh K Mishra1, Sharmila Dorbala, Giridhar Logsetty

  • 1Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Journal of the American College of Cardiology
|February 15, 2005
PubMed

Insights

Changes in heart rate and blood pressure during adenosine infusion do not reliably predict myocardial blood flow or coronary vascular resistance. These hemodynamic changes should not be used to assess vasodilator stress effectiveness in myocardial perfusion imaging.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Medical Imaging

Background:

  • The relationship between myocardial blood flow (MBF) and peripheral hemodynamic changes during adenosine infusion is not well understood.
  • Assessing vasodilator stress effectiveness in myocardial perfusion imaging is crucial for accurate diagnosis.

Purpose of the Study:

  • To investigate the correlation between changes in cardiac hemodynamics (heart rate and mean arterial pressure) and myocardial blood flow (MBF) during intravenous adenosine infusion.
  • To determine if hemodynamic responses to adenosine can predict coronary vascular resistance (CVR).

Main Methods:

  • 348 patients without obstructive coronary artery disease underwent [(13)N]ammonia Positron Emission Tomography (PET) imaging.
  • MBF and CVR were measured at rest and during a 6-minute intravenous adenosine infusion.
  • Changes in heart rate (HR) and mean arterial pressure (MAP) were recorded during peak hyperemia.

Main Results:

  • Adenosine infusion increased HR and decreased MAP, but these changes showed poor correlation with hyperemic MBF and CVR.
  • Patients with lower delta HR had significantly lower hyperemic MBF and higher CVR.
  • Lower delta MAP (greater decline) was associated with similar hyperemic MBF and lower CVR, with no statistical significance.

Conclusions:

  • Hemodynamic changes during adenosine infusion are generally poor predictors of MBF and CVR.
  • These hemodynamic parameters should not be relied upon to assess vasodilator stress effectiveness in myocardial perfusion imaging.
Abstract

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