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Intracoronary electrocardiogram ST segment shift evaluation during intravenous adenosine infusion: a comparison with
Vruyr Balian1, Claudio Marcassa, Michele Galli
1Department of Cardiology, Yozgat State Hospital, Turkey. vbalian@aobusto.it
Insights
Intracoronary ECG ST segment shifts during adenosine infusion can accurately estimate fractional flow reserve (FFR) in coronary stenosis. This method may reduce the need for invasive FFR measurements.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Fractional flow reserve (FFR) measures pressure decline across coronary narrowing to assess stenosis significance.
- Intracoronary electrocardiogram (IC-ECG) is more sensitive than standard ECG for detecting regional ischemia.
Purpose of the Study:
- To evaluate if unipolar IC-ECG ST segment recording during vasodilation can indirectly estimate FFR.
- To determine the diagnostic accuracy of IC-ECG for assessing functional significance of coronary stenosis.
Main Methods:
- Forty-eight stable patients with intermediate coronary stenosis underwent FFR and IC-ECG during adenosine infusion.
- Adenosine was used for maximal pharmacologic vasodilation to elicit ischemia.
Main Results:
- FFR values indicated significant stenosis (≤ 0.80) in 54% of patients.
- IC-ECG showed significant ST segment shifts (IST) in 50% of patients, compared to only 19% with standard ECG abnormalities.
- IST demonstrated 81% sensitivity and 86% specificity for predicting abnormal FFR.
Conclusions:
- Intracoronary ST segment shift during adenosine infusion is valuable for assessing borderline coronary stenosis.
- The presence of IST may obviate the need for invasive FFR measurements, simplifying stenosis evaluation.
Background:
By measuring the pressure decline caused by coronary narrowing, fractional flow reserve (FFR) is an index of the physiological significance of a vessel stenosis. Intracoronary electrocardiogram (IC-ECG) recording from an angioplasty guidewire is more sensitive than standard ECG in detecting regional myocardial ischemia. The aim of the study was to assess if unipolar IC-ECG ST segment recording from angioplasty guidewire during maximal pharmacologic vasodilation could be used as an indirect estimation of FFR results.
Methods:
Forty-eight clinically stable patients with intermediate stenosis underwent FFR evaluation and IC-ECG recording during intravenous adenosine infusion.
Results:
FFR values were ≤ 0.80 in 26 (54%) patients and > 0.80 in 22 (46%). After adenosine, standard ECG was abnormal in only nine (19%) patients, while IC-ECG showed a significant ST segment shift (IST) in 24 (50%) patients: ST elevation in 19 patients and depression in five). IST was documented in 21/26 patients with FFR ≤ 0.80 (81%) and in 3/22 with FFR > 0.80 (p < 0.001). Sensitivity of IST for predicting an abnormal FFR value was 81%, specificity 86%, positive and negative predictive accuracies were 88% and 79%, respectively.
Conclusions:
Intracoronary ST segment shift evaluation during adenosine infusion may be of value in assessing the functional significance of a borderline stenosis. The presence of IST during adenosine infusion could obviate the need for additional FFR evaluation.
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