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

doi:10.5603/cj.21178

Vol 18, No 6 (2011)

Original articles

Submitted: 2013-01-14

Published online: 2011-11-23

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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

DOI: 10.5603/cj.21178

Cardiol J 2011;18(6):662-667.

Vol 18, No 6 (2011)

Original articles

Submitted: 2013-01-14

Published online: 2011-11-23

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. (Cardiol J 2011; 18, 6: 662–667)