title: Intracoronary electrocardiogram ST segment shift evaluation during intravenous adenosine infusion: a comparison with fractional flow reserve.
abstract: BACKGROUND
  By measuring the pressure decline caused by coronary narrowing, fractional flow reserve (FFR) is an index of the physiological significance of a vessel stenosis. Intracoronary electrocardiogram (IC-ECG) recording from an angioplasty guidewire is more sensitive than standard ECG in detecting regional myocardial ischemia. The aim of the study was to assess if unipolar IC-ECG ST segment recording from angioplasty guidewire during maximal pharmacologic vasodilation could be used as an indirect estimation of FFR results.
  
  
  METHODS
  Forty-eight clinically stable patients with intermediate stenosis underwent FFR evaluation and IC-ECG recording during intravenous adenosine infusion.
  
  
  RESULTS
  FFR values were ≤ 0.80 in 26 (54%) patients and > 0.80 in 22 (46%). After adenosine, standard ECG was abnormal in only nine (19%) patients, while IC-ECG showed a significant ST segment shift (IST) in 24 (50%) patients: ST elevation in 19 patients and depression in five). IST was documented in 21/26 patients with FFR ≤ 0.80 (81%) and in 3/22 with FFR > 0.80 (p < 0.001). Sensitivity of IST for predicting an abnormal FFR value was 81%, specificity 86%, positive and negative predictive accuracies were 88% and 79%, respectively.
  
  
  CONCLUSIONS
  Intracoronary ST segment shift evaluation during adenosine infusion may be of value in assessing the functional significance of a borderline stenosis. The presence of IST during adenosine infusion could obviate the need for additional FFR evaluation.
authors: Department of Cardiology, Yozgat State Hospital, Turkey. vbalian@aobusto.it
authors: Vruyr
authors: V
authors: Balian
authors: Claudio
authors: C
authors: Marcassa
authors: Michele
authors: M
authors: Galli
authors: Gianni
authors: G
authors: Cecchin
authors: Riccardo
authors: R
authors: Michi
authors: Marco
authors: M
authors: Crenna
authors: Ettore
authors: E
authors: Petrucci
authors: Marco
authors: M
authors: Onofri
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine