Prognostic significance of ST-segment depression during adenosine perfusion imaging
E S Marshall1, J S Raichlen, S M Kim
1Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Insights
ST-segment depression during adenosine perfusion imaging, especially greater than or equal to 2 mm, significantly predicts future cardiac events. This finding adds valuable prognostic information beyond traditional clinical assessments and imaging results.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Prediction
Background:
- Adenosine perfusion imaging is a key diagnostic tool for assessing myocardial perfusion.
- ST-segment depression during adenosine stress testing can indicate myocardial ischemia.
- The prognostic significance of ST-segment depression during adenosine perfusion imaging requires further elucidation.
Purpose of the Study:
- To evaluate the predictive value of ST-segment depression during adenosine perfusion imaging for future cardiac events.
- To determine if ST-segment depression provides additional prognostic information beyond established clinical and imaging markers.
Main Methods:
- Retrospective analysis of 188 patients with interpretable electrocardiograms post-adenosine testing.
- Assessment of ST-segment depression (≥1 mm and ≥2 mm) during adenosine infusion.
- Follow-up for cardiac events including cardiac death, myocardial infarction, unstable angina, and revascularization.
Main Results:
- ST-segment depression (≥1 mm) occurred in 17% of patients; ≥2 mm in 5.3%.
- Multivariate analysis identified ≥2 mm ST-segment depression as the strongest independent predictor of cardiac events (RR=6.5, p=0.0001).
- Other independent predictors included left ventricular dilation, prior coronary angioplasty, prior non-Q-wave myocardial infarction, and reversible perfusion defects.
Conclusions:
- ST-segment depression during adenosine infusion is uncommon but clinically significant.
- ≥2 mm ST-segment depression is a powerful independent predictor of future cardiac events.
- This finding enhances risk stratification beyond clinical variables and perfusion imaging results.
Abstract:
To determine the significance of ST-segment depression during adenosine perfusion imaging for predicting future cardiac events, 188 patients with interpretable electrocardiograms were assessed 1 to 3 years (mean 21.5 +/- 6.6 months) after adenosine testing. At least 1 mm of ST-segment depression was observed in 32 (17%) patients, with > or = 2 mm of ST-segment depression in 10 (5.3%). Thirty-seven cardiac events occurred during the study period: 2 cardiac deaths, 5 nonfatal myocardial infarctions, 6 admissions for unstable angina, and 24 revascularizations. Univariate predictors of events were a history of congestive heart failure, previous non-Q-wave myocardial infarction, previous coronary angioplasty, use of antianginal medication, ST-segment depression during adenosine infusion (particularly > or = 2 mm), any reversible perfusion defect, transient left ventricular cavity dilation, and the severity of perfusion defects. Multivariate analysis identified > or = 2 mm ST-segment depression as the most significant predictor of cardiac events (relative risk [RR] = 6.5; p = 0.0001). Other independent predictors of events were left ventricular dilation (RR = 3.8; p = 0.002), previous coronary angioplasty (RR = 3.3; p = 0.001), a history of non-Q-wave myocardial infarction (RR = 2.3; p = 0.01), and the presence of any reversible defect (RR = 2.0; p = 0.05). We conclude that ST-segment depression occurs uncommonly during adenosine infusion, but the presence of > or = 2 mm of ST-segment depression is an independent predictor of future cardiac events and provides information in addition to that obtained from clinical variables and the results of adenosine perfusion imaging.
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