Correlation of adenosine thallium 201 perfusion patterns with markers for inducible ischemia.
To determine the frequency of true myocardial ischemia caused by hemodynamic, metabolic, and regional functional abnormalities after intravenous adenosine infusion in patients with coronary artery disease, 13 patients--11 with coronary artery disease--received intravenous adenosine and thallium 201 during cardiac catheterization. Intracoronary adenosine levels increased by an average of 9.4-fold over baseline. Of the 11 patients, all had > or = 70% stenoses with a mean number of redistribution defects per patient of 3.3 +/- 0.7. Only two (18%) patients had new wall motion abnormalities detected by echocardiography during adenosine infusion. Pulmonary capillary wedge pressure did not significantly rise (13 +/- 7 to 17 +/- 8 mm Hg, p= NS). Lactate production occurred in two patients. Coronary sinus oxygen saturation levels rose from 29% +/- 6% to 68% +/- 8%, consistent with less myocardial oxygen extraction. Thus, despite a high prevalence of defects detected by 201Tl, the prevalence of true myocardial ischemia in patients with coronary artery disease undergoing pharmacologic stress imaging with intravenous adenosine is low. Perfusion defects induced by vasodilator stress are predominantly caused by heterogeneity of flow reserve rather than true ischemia.
Fenster
M S
MS
Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Feldman
M D
MD
Camarano
G
G
Johnson
W H
WH
Ellis
M
M
Linden
J
J
Beller
G A
GA
D000241:Adenosine; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D006321:Heart / Q000000981:diagnostic imaging*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D014665:Vasodilator Agents
D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D019344:Lactic Acid; D000241:Adenosine