EFFECTS OF ADENOSINE ON LEFT-VENTRICULAR FILLING DYNAMICS IN PATIENTSWITH AND WITHOUT CORONARY-ARTERY DISEASE - A DOPPLER-ECHOCARDIOGRAPHIC STUDY

Objectives Adenosine, a potent coronary vasodilator is used as a pharm acologic stress agent for the assessment of coronary artery disease. A paucity of data exists on its effects on filling dynamics. Accordingl y, this study was undertaken to evaluate the effects of adenosine on l eft ventricular filling as assessed by Doppler echocardiography. Metho ds and Results We studied 69 patients (45 men, 24 women, aged 61 +/- 1 1 years) referred for evaluation of coronary artery disease. Two-dimen sional echocardiography and pulsed-Doppler recordings at the mitral va lve tips and annulus were performed at baseline and at maximal adenosi ne infusion of 140 mu g/kg/min. During adenosine infusion, an increase in heart rate occurred (70 +/- 14 beats/min to 85 +/- 16 beats/min), with a mild decrease in blood pressure (130/75 +/- 26/13 mm Hg vs 119/ 66 +/- 25/13 mm Hg); both p < 0.02. Changes in filling dynamics includ ed an increase in peak early inflow velocity, E/A ratio, and normalize d peak filling rate. Of the patients investigated, 23 had one-vessel c oronary artery disease, 29 had coronary disease in two vessels or more by angiography, and 17 had no significant disease. Patients without c oronary artery disease (controls) had mild changes in E/A ratio (mean 7%). Patients with coronary artery disease had a more heterogeneous ch ange in Filling dynamics (range 43% to 369%, mean 26%), with a signifi cant overlap with controls. However, changes in E/A ratio during adeno sine infusion that exceeded the confidence limits of normal (-20% to 30%) were specific for coronary artery disease, with a positive predic tive value of 84%. Conclusions Normally, adenosine induces significant increases in early filling as assessed by Doppler. The changes in pat ients with coronary stenosis are more variable. When these changes fal l outside the confidence limits of normal, they are predictive of coro nary artery disease.