Prevalence of ECG changes during adenosine stress and its association with perfusion defect on myocardial perfusion scintigraphy

Taywade, Sameer; Ramaiah, Vijayaraghavan L; Basavaraja, Harish; Venkatasubramaniam, Parameswaran R.; Selvakumar, Job

doi:10.1097/mnm.0000000000000650

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…This discordant-positive ECG changes could be due to digoxin-like vasoconstrictor effect of estrogen during stress. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

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Technetium-99m Methoxyisobutyl Isonitrile Stress MPI in Suspected Coronary Artery Disease Patients: A Prospective Study to Evaluate Clinical Significance of Adenosine-induced ECG Changes

Valaiyapathy,

Rallapeta,

Hemalatha

et al. 2024

Indian Journal of Nuclear Medicine

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Purpose: The purpose of this study is to evaluate the adenosine pharmacological stress-induced electrocardiogram (ECG) changes and their association with stress-induced ischemic defects on myocardial perfusion scintigraphy (MPS) in the evaluation of coronary artery disease (CAD) and to evaluate event-free survival among patients with positive and negative ECG/MPS image findings. Methods: A total of 100 patients were examined using stress MPS from March 2020 to August 2021. Stress-induced ECG changes during adenosine infusion were evaluated. The summed stress score (SSS) was evaluated to identify ischemic defects in myocardium. Association of stress ECG changes and scintigraphic results was evaluated. Results: Out of 100 patients, stress ECG changes during adenosine infusion were seen among 34 patients, whereas 66 patients had normal ECG findings. Positive stress MPS findings with SSS >3 were seen in 22 patients, whereas 78 patients had SSS ≤3. There was no agreement between stress ECG changes and MPS findings with Cohen’s kappa coefficient (κ) = −0.023, whereas there was mild agreement between stress ECG changes and SSS >7 with κ = 0.105. Median follow-up of 11 months showed more events among patients with positive ECG changes than negative ECG changes. Conclusion: Adenosine, pharmacological stress is safe to use, but few patients might experience some minor and transient symptoms. Adenosine may induce ECG changes in patients with or without positive MPS findings. Patients with concordant positive findings need aggressive cardiac care, whereas patients with small or no defects on MPS need close monitoring.

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“…This discordant-positive ECG changes could be due to digoxin-like vasoconstrictor effect of estrogen during stress. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

“…showed moderate strength of association between adenosine ECG changes and myocardial perfusion image findings. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

Technetium-99m Methoxyisobutyl Isonitrile Stress MPI in Suspected Coronary Artery Disease Patients: A Prospective Study to Evaluate Clinical Significance of Adenosine-induced ECG Changes

Valaiyapathy,

Rallapeta,

Hemalatha

et al. 2024

Indian Journal of Nuclear Medicine

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T-wave changes on ECG during myocardial perfusion SPECT

Lee

Lyall

Chik

2022

Journal of Electrocardiology

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Relation between pharmacological stress ECG, 13NH3-PET/CT outcome and the occurrence of cardiac events during follow-up in women with chest pain

Zant

Wondergem

Lazarenko

et al. 2020

Nuclear Medicine Communications

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Aim Evaluation of major adverse cardiovascular events (MACE) in women referred for 13NH3-PET/CT in relation to scan outcome and pharmacological stress ECG (PxECG) results. Patients and methods Six hundred twenty-four women, referred for 13NH3-PET/CT between 2012 and 2016, were included. Demographic data and MACE during follow-up (407 ± 207 days) were retrieved from electronic patient charts. 13NH3-PET/CT was scored as either normal or abnormal. PxECG was scored as negative, non-diagnostic or positive. PxECG was compared with 13NH3-PET/CT and related to MACE. Results The 13NH3-PET/CT was normal in 482/624 (77%) and abnormal in 142/624 (23%). PxECG was negative in 234/624 (38%), non-diagnostic in 365/624 (58%) and positive in 25/624 (4%). 13NH3-PET/CT was normal in 87, 71 and 72% with normal, nondiagnostic and positive PxECG, respectively. 41/624(7%) experienced a MACE, 38 with abnormal 13NH3-PET/CT versus three with normal 13NH3-PET/CT (P < 0.001). MACE occurred in 5/234 (0.9%), 31/365 (8%) and 5/25 (20%) with normal, non-diagnostic and positive PxECG, respectively (P < 0.001). No MACEs were seen in 204 with both normal PxECG and 13NH3-PET/CT versus 5/30(17%) with normal PxECG but abnormal 13NH3-PET/. No MACE occurred in 3/260(1%) with non-diagnostic PxECG and normal 13NH3-PET/CT versus 28/105(27%) with non-diagnostic PxECG and abnormal 13NH3-PET/CT. 0/18 with positive PxECG and normal 13NH3-PET/CT showed MACE versus 5/7(71%) with a positive PxECG and abnormal 13NH3-PET/CT. Conclusion Normal 13NH3-PET/CT is most prevalent in women with normal PxECG. The occurrence of MACE during follow-up is more frequently related to an abnormal 13NH3-PET/CT than to PxECG. Furthermore, in women with positive PxECG but normal 13NH3-PET/CT no MACE are to be expected.

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Prevalence of ECG changes during adenosine stress and its association with perfusion defect on myocardial perfusion scintigraphy

Abstract: 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.

Cited by 3 publications

References 20 publications

Technetium-99m Methoxyisobutyl Isonitrile Stress MPI in Suspected Coronary Artery Disease Patients: A Prospective Study to Evaluate Clinical Significance of Adenosine-induced ECG Changes

Technetium-99m Methoxyisobutyl Isonitrile Stress MPI in Suspected Coronary Artery Disease Patients: A Prospective Study to Evaluate Clinical Significance of Adenosine-induced ECG Changes

T-wave changes on ECG during myocardial perfusion SPECT

Relation between pharmacological stress ECG, 13NH3-PET/CT outcome and the occurrence of cardiac events during follow-up in women with chest pain

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