The haemodynamic response to ST segment changes during coronary arteriography

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Contrast media used in coronary arteriography can induce electrocardiographic and hemodynamic alterations.
• Clinical decisions to repeat procedures are often based on patient symptoms like chest pain, bradycardia, or hypotension.

Purpose of the Study:

• To investigate the relationship between ST segment changes and left ventricular end-diastolic pressure during coronary arteriography.
• To correlate these changes with different patient groups including coronary artery disease, syndrome X, and coronary artery spasm.

Main Methods:

• Studied 25 patients undergoing coronary arteriography: 15 with coronary artery disease, 2 with syndrome X, 3 with coronary artery spasm, and 5 controls.
• Monitored ST segment changes and measured pulmonary arterial diastolic pressure using a transducer-tipped catheter to infer left ventricular filling pressure.

Main Results:

• Normal controls showed no significant changes.
• Syndrome X patients exhibited ST segment depression without hemodynamic alterations.
• Coronary artery spasm and coronary artery disease patients demonstrated ST segment depression concurrent with increased pulmonary arterial diastolic pressure.
• Repeated contrast injections sometimes led to a summation effect, exacerbating ST segment disturbances and left ventricular filling pressure.

Conclusions:

• Coronary arteriography with contrast media can precipitate significant ST segment disturbances and elevate left ventricular filling pressures.
• These hemodynamic changes are particularly evident in patients with coronary artery disease and spasm, even in the absence of overt symptoms.