Intracoronary electrocardiogram ST segment shift evaluation during intravenous adenosine infusion: A comparison with fractional flow reserve

Vruyr Balian, Claudio Marcassa, Michele Galli, Gianni Cecchin, Riccardo Michi, Marco Crenna, Ettore Petrucci, Marco Onofri

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)662-667
Number of pages6
JournalCardiology Journal
Volume18
Issue number6
Publication statusPublished - 2011

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Intravenous Infusions
Adenosine
Electrocardiography
Pathologic Constriction
Angioplasty
Vasodilation
Myocardial Ischemia
Pressure

Keywords

  • Adenosine
  • Angioplasty
  • Electrocardiography
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Intracoronary electrocardiogram ST segment shift evaluation during intravenous adenosine infusion : A comparison with fractional flow reserve. / Balian, Vruyr; Marcassa, Claudio; Galli, Michele; Cecchin, Gianni; Michi, Riccardo; Crenna, Marco; Petrucci, Ettore; Onofri, Marco.

In: Cardiology Journal, Vol. 18, No. 6, 2011, p. 662-667.

Research output: Contribution to journalArticle

Balian, V, Marcassa, C, Galli, M, Cecchin, G, Michi, R, Crenna, M, Petrucci, E & Onofri, M 2011, 'Intracoronary electrocardiogram ST segment shift evaluation during intravenous adenosine infusion: A comparison with fractional flow reserve', Cardiology Journal, vol. 18, no. 6, pp. 662-667.
Balian, Vruyr ; Marcassa, Claudio ; Galli, Michele ; Cecchin, Gianni ; Michi, Riccardo ; Crenna, Marco ; Petrucci, Ettore ; Onofri, Marco. / Intracoronary electrocardiogram ST segment shift evaluation during intravenous adenosine infusion : A comparison with fractional flow reserve. In: Cardiology Journal. 2011 ; Vol. 18, No. 6. pp. 662-667.
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AU - Balian, Vruyr

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AU - Michi, Riccardo

AU - Crenna, Marco

AU - Petrucci, Ettore

AU - Onofri, Marco

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N2 - 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.

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