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ST/HR slope during prostacyclin treatment: an improved method to identify patients with advanced coronary artery

R Bugiardini1, A Borghi, G Morgagni

  • 1Institute of Patologia Medica, University of Bologna, Italy.

European Heart Journal
|November 1, 1989
PubMed

Insights

Iloprost improved the accuracy of the ST/HR slope test in diagnosing coronary artery disease severity. This prostacyclin analogue enhanced coronary flow reserve, particularly in patients with less severe atherosclerosis.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • Exercise-induced coronary artery constriction can reduce coronary flow reserve.
  • This constriction may limit the accuracy of the ST/HR slope in assessing coronary artery disease severity.

Purpose of the Study:

  • To evaluate the effect of iloprost-induced coronary vasodilation on the diagnostic accuracy of the ST/HR slope.
  • To compare ST/HR slopes during placebo versus iloprost administration in patients with coronary artery disease.

Main Methods:

  • 42 patients with angina and coronary artery disease underwent exercise testing with ST/HR slope analysis.
  • Tests were performed with placebo and during infusion of iloprost (a prostacyclin analogue).
  • A subset of patients (n=7) underwent repeat testing during right heart catheterization.

Main Results:

  • Iloprost improved the overall diagnostic accuracy of the ST/HR slope compared to placebo, especially in advanced coronary artery disease.
  • A rightward shift in the ST/HR slope was observed with iloprost in one- and two-vessel disease, but not in three-vessel or left main stem disease.
  • Higher coronary blood flow during iloprost infusion suggests prevention of dynamic coronary events, potentially benefiting patients with minor atherosclerosis.

Conclusions:

  • Iloprost enhances the diagnostic utility of the ST/HR slope for coronary artery disease severity.
  • The drug's benefits appear more pronounced in patients with less advanced atherosclerotic disease.
  • Iloprost may mitigate exercise-induced reductions in coronary flow reserve through prevention of dynamic coronary events.

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