title: Prevalence of ECG changes during adenosine stress and its association with perfusion defect on myocardial perfusion scintigraphy.
abstract: OBJECTIVE
  Myocardial perfusion scintigraphy (MPS) is a valuable, noninvasive imaging modality in the evaluation of patients with coronary artery disease. Adenosine stress may occasionally be associated with ECG changes. This study evaluated the strength of association between adenosine stress-related ECG changes and perfusion defects on Tc-MPS.
  
  
  METHODS
  117 (mean age: 61.25±9.27 years; sex: men 87, women 30) patients with known/suspected coronary artery disease underwent adenosine stress MPS. ECG was monitored continuously during adenosine stress for ST-depression. On the basis of the summed difference score, reversible perfusion defects were categorized as follows: normal: less than 4, mild: 4-8, moderate: 9-13, and severe: more than 13.
  
  
  RESULTS
  ST-depression was observed in 27/117 (23.1%) and reversible perfusion defects were observed in 18/27 (66.66%) patients. 2/27, 6/27, and 10/27 patients had mild, moderate, and severe ischemia, respectively. 9/27 patients had normal perfusion. ECG changes and perfusion defects showed a moderate strength of association (correlation coefficient r=0.35, P=0.006). The sensitivity, specificity, positive predictive value, and negative predictive value of ECG findings for prediction of ischemia were 35.29, 86.36, 67.67, and 63.33%, respectively.
  
  
  CONCLUSIONS
  ECG changes during adenosine stress are not uncommon. It shows a moderate strength of association with reversible perfusion defects. ECG changes during adenosine merit critical evaluation of MPS findings.
authors.affiliation: Department of Nuclear Medicine, Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, Karnataka, India.
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Taywade
authors.forename: Vijayaraghavan L
authors.initials: VL
authors.lastname: Ramaiah
authors.forename: Harish
authors.initials: H
authors.lastname: Basavaraja
authors.forename: Parameswaran R
authors.initials: PR
authors.lastname: Venkatasubramaniam
authors.forename: Job
authors.initials: J
authors.lastname: Selvakumar
mesh_terms: D000241:Adenosine; D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine