Circulation, Vol 89, 278-284, Copyright © 1994 by American Heart Association
S Borges-Neto, J Puma, RH Jones, MH Sketch Jr, R Stack, MW Hanson and RE Coleman
BACKGROUND: The purpose of this investigation was to compare the magnitude
of change in myocardial perfusion and function during exercise with that
obtained during total coronary artery occlusion. Radionuclide studies are
widely used for the diagnosis and determination of prognosis in patients
with suspected or known coronary artery disease. These studies are based on
the premise that the relative deficit of coronary blood flow, which is
induced by exercise and recognized as increased demand, relates to the
jeopardy experienced by the decrease or sudden absolute interruption of
coronary blood flow that is recognized as decreased supply and is
associated with coronary stenosis or total coronary artery occlusion. The
magnitude of exercise- induced perfusion and function abnormalities
compared with those induced by total coronary artery occlusion in humans
has not been previously reported. METHODS AND RESULTS: We prospectively
studied 20 patients with > or = 50% diameter stenosis documented by
quantitative coronary angiography in at least one vessel. A same-day
rest/exercise sestamibi myocardial function and perfusion study was
performed within 24 hours before percutaneous transluminal coronary
angioplasty. At 1 minute after balloon inflation, while the vessel was
occluded, sestamibi was injected, and a myocardial perfusion and function
study was performed. Perfusion defect size was greater during occlusion (28
+/- 3%) than during exercise (13 +/- 2%) (P < .01). Ejection fraction
was greater during exercise (53 +/- 3%) compared with values measured
during occlusion (41 +/- 2%) (P < .01). CONCLUSIONS: Physiological
abnormalities induced by coronary occlusion are greater than those that
occur during exercise, thereby indicating that stress-induced ischemia may
not reflect the total potential myocardium in jeopardy from a stenotic
lesion, if sudden occlusion occurs.
ARTICLES
Myocardial perfusion and ventricular function measurements during total coronary artery occlusion in humans. A comparison with rest and exercise radionuclide studies
Department of Radiology (Nuclear Medicine), Duke University Medical Center, Durham, NC.
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