Circulation, Vol 87, 1211-1219, Copyright © 1993 by American Heart Association
S Nishimura, KT Kimball, JJ Mahmarian and MS Verani
BACKGROUND. Myocardial ischemia attributed to coronary steal may occur in
some patients receiving pharmacological coronary vasodilation. ECG
ST-segment depression is a marker of myocardial ischemia in these patients,
but the factors determining the presence or absence of ischemia are not
well known. METHODS AND RESULTS. To examine the angiographic, hemodynamic,
and scintigraphic determinants of adenosine- induced ischemic ST-segment
depression in patients with coronary artery disease, we studied 65
consecutive patients (45 men and 20 women; mean age, 65 +/- 12 years) who
showed reversible perfusion defects during adenosine (140
micrograms.kg-1.min-1 for 6 minutes) 201Tl single-photon emission computed
tomography. Patients with prior myocardial infarction were excluded.
Ischemic ST depression occurred in one third of the whole cohort (22 of 65
patients). The presence of coronary collateral vessels (p = 0.001),
systolic blood pressure at baseline (p = 0.006), and adenosine-induced
anginal chest pain (p = 0.011) were the only significant independent
predictors of ischemic ST-segment depression by stepwise logistic
regression analysis. Rate-pressure product at baseline, systolic blood
pressure, heart rate, rate-pressure product, increase in heart rate, and
rate-pressure product during adenosine infusion and maximal percent
stenosis were variables also significantly related to ischemic ST
depression by univariate analysis but were not predictive after the three
primary variables were included in the regression model. Perfusion defect
size, number of diseased vessels, and age did not correlate with ST-segment
depression. CONCLUSIONS. The presence of collaterals, which may predispose
to coronary collateral steal, is the most significant correlate of ischemic
ST-segment depression during adenosine infusion. Systolic blood pressure at
baseline, which may affect the myocardial oxygen supply/demand ratio and
anginal chest pain induced by adenosine, are additional variables related
to ischemic ST-segment depression during adenosine infusion.
ARTICLES
Angiographic and hemodynamic determinants of myocardial ischemia during adenosine thallium-201 scintigraphy in coronary artery disease
Department of Medicine, Baylor College of Medicine, Houston, Tex.
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