CLINICAL DETERMINANTS OF HEMODYNAMIC AND SYMPTONATIC RESPONSES IN 2,000 PATIENTS DURING ADENOSINE SCINTIGRAPHY

Objective: To determine whether subsets of patients referred for a cli nically indicated radionuclide adenosine stress study respond differen tly to a standard infusion of adenosine. Material and Methods: We asse ssed multiple clinical and hemodynamic variables in the first 2,000 pa tients who underwent adenosine perfusion studies in our laboratory, A relevant clinical variable was defined as one that was significantly a ssociated with changes in heart rate and blood pressure during adenosi ne infusion, Relevant clinical variables that were most significantly related to hemodynamic variables included age, gender, rhythm (atrial fibrillation), diabetes, and left ventricular function, These variable s were then related to symptomatic responses (adverse effects) to aden osine infusion, To determine whether the different peripheral response s to adenosine reflected clinically important differences in coronary vasodilation,, we compared perfusion imaging with coronary angiographi c findings in the 408 patients who underwent both studies within 6 mon ths of each other. Results: The decrease in systolic blood pressure wa s greater and the reflex tachycardia was less in patients 70 years of age or older and in those with insulin-dependent diabetes in compariso n with younger patients and those without type 1 diabetes, Men Rad sma ller decreases in blood pressure and smaller increases in heart rate t han did women, Patients with atrial fibrillation and those with left v entricular ejection fraction less than 40% had smaller decreases in bl ood pressure and smaller increases in heart irate than did those in si nus rhythm or those with an ejection fraction of 40% or more, Age 70 y ears or older, male gender, atrial fibrillation, and left ventricular ejection fraction less than 40% were associated with fewer symptoms an d less severe chest pain in comparison with patients without these var iables, For patients with coronary angiograms, the relationship betwee n coronary artery disease evident on angiography and perfusion abnorma lities noted on scintigraphy mas not different for any of the relevant clinical variables. Conclusion: Common clinical patient subsets are a ssociated with different peripheral hemodynamic and symptomatic respon ses to infusion of adenosine. Despite these observations, however, the ability to detect coronary artery disease with perfusion imaging is n ot obviously altered.