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Adenosine-echocardiography for the detection of coronary artery disease
1First Department of Internal Medicine, Yamagata University School of Medicine.
Insights
Adenosine-echocardiography effectively detects multi-vessel coronary artery disease. This non-invasive method assesses wall motion and myocardial perfusion, improving diagnosis of coronary artery disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis relies on accurate detection of myocardial ischemia.
- Non-invasive imaging modalities are crucial for assessing CAD severity.
Purpose of the Study:
- To evaluate the efficacy of adenosine-echocardiography in detecting coronary artery disease.
- To compare adenosine-echocardiography with thallium-201 single photon emission computed tomography (SPECT).
Main Methods:
- 39 patients underwent intravenous adenosine infusion with continuous echocardiography.
- Thallium-201 SPECT was performed for myocardial perfusion imaging.
- Abnormal ischemic response defined as transient reduction in systolic wall motion post-adenosine.
Main Results:
- Echocardiography identified wall motion abnormalities in 17/39 patients.
- Thallium-201 redistribution observed in 28/39 patients.
- Overall agreement between methods was 62%; sensitivity for multi-vessel disease was 76% (vs. 21% for single-vessel disease).
Conclusions:
- Adenosine-echocardiography is particularly useful for detecting multi-vessel coronary artery disease.
- Simultaneous assessment of wall motion and perfusion enhances functional description of ischemic myocardial segments.
- Adenosine-echocardiography is a well-tolerated diagnostic tool for coronary artery disease.
Abstract:
The use of adenosine-echocardiography to detect coronary artery disease was evaluated in 39 patients. Adenosine was infused intravenously at 0.14 mg/kg/min for 6 minutes with continuous recordings of two-dimensional echocardiography. Three minutes after the start of adenosine infusion, thallium (201Tl) was administered into a separate vein. Myocardial single photon emission computed tomography (SPECT) images were obtained 10 minutes and 3 hours after the 201Tl injection. Transient reduction of systolic wall motion after adenosine infusion was considered an abnormal ischemic response. Echocardiography detected a wall motion abnormality after adenosine infusion in 17 of 39 patients. 201Tl redistribution was observed in 28 patients. Agreements for the presence of myocardial ischemia or infarction between 201Tl SPECT and echocardiography were 62% (24/39). The sensitivity of echocardiography in patients with single-vessel disease was 21%, but 76% with multi-vessel disease (p < 0.01 vs single-vessel disease). All side effects were tolerated well and disappeared within 1 or 2 minutes after stopping adenosine infusion. Adenosine-echocardiography was particularly useful for the detection of multiple-vessel coronary disease. Simultaneous evaluation of wall motion and myocardial perfusion during adenosine-induced maximal coronary vasodilation may improve the functional description of diseased myocardial segments.