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Diagnosis of ischemic heart disease with adenosine echocardiography
W A Zoghbi1, J Cheirif, N S Kleiman
1Department of Medicine, Baylor College of Medicine, Houston, Texas 77030.
Insights
Adenosine infusion combined with echocardiography is a feasible and safe method for diagnosing coronary artery disease. This diagnostic approach shows high sensitivity and specificity, particularly for identifying multivessel disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Background:
- Coronary artery disease (CAD) diagnosis often requires invasive procedures.
- Non-invasive methods are sought to improve diagnostic accuracy and patient safety.
- Adenosine stress testing is a recognized technique for evaluating myocardial ischemia.
Purpose of the Study:
- To evaluate the feasibility, safety, and diagnostic accuracy of adenosine infusion combined with echocardiography in patients with suspected or known CAD.
- To compare the diagnostic performance of adenosine echocardiography with coronary angiography.
Main Methods:
- Seventy-three patients with suspected or known CAD underwent baseline and adenosine-infused echocardiography.
- Maximal intravenous adenosine infusion (140 µg/kg/min) was administered.
- Echocardiographic images were digitized for blinded, randomized interpretation; coronary angiography was performed for comparison.
Main Results:
- Adenosine infusion induced expected hemodynamic changes (increased heart rate, decreased blood pressure).
- Adenosine echocardiography demonstrated 85% sensitivity and 92% specificity for detecting ≥75% coronary artery stenosis.
- Sensitivity was 60% in patients with normal baseline ECGs; 82% of multivessel disease cases were identified.
Conclusions:
- Adenosine-induced echocardiography is a sensitive and specific non-invasive tool for assessing ischemic heart disease.
- The method is particularly effective in identifying patients with multivessel coronary artery disease.
- Observed side effects were transient and mild, supporting the safety profile of the procedure.
Abstract:
To assess the feasibility, safety and diagnostic accuracy of adenosine infusion combined with echocardiography, 73 patients with suspected or known coronary artery disease underwent echocardiography at baseline and during a maximal intravenous adenosine infusion of 140 micrograms/kg per min. Compared with baseline values, adenosine caused an increase in heart rate, a decrease in systolic and diastolic blood pressure and a slight but significant increase in rate-pressure product. The echocardiographic images were digitized and randomly assigned in a quad-screen format for nonbiased interpretation. An ischemic response, defined as a new or worsening wall motion abnormality, developed in 25 patients; a fixed wall motion abnormality was present in 27 and no abnormality in 21. All patients underwent coronary angiography. The sensitivity of adenosine echocardiography for greater than or equal to 75% coronary artery diameter stenosis was 85% (46 of 54), with a specificity of 92% in patients with normal coronary arteries. In the 35 patients with a normal baseline electrocardiogram the sensitivity was 60%; 9 (82%) of 11 patients with multivessel disease were correctly identified. The sensitivity for adenosine electrocardiography (greater than or equal to 1-mm ST depression) was 35% with a specificity of 100%. Side effects were transient and mild; aminophylline was used in two patients. Thus, ischemic changes can be induced in patients with coronary artery disease with intravenous adenosine that, combined with echocardiography, is sensitive for the assessment of ischemic heart disease, particularly in patients with multivessel disease.