Adenosine-induced heterogeneous perfusion accompanies myocardial ischemia in the presence of advanced coronary artery disease.

The aim of the present study was to elucidate the characteristics of patients in whom transient myocardial ischemia was evoked during adenosine infusion. Thallium-201 (Tl-201) myocardial imaging and two-dimensional echocardiography during adenosine infusion were performed simultaneously in 61 consecutive patients enrolled for the diagnosis of coronary artery disease. Transient reduction of systolic wall motion after adenosine infusion was considered evidence of myocardial ischemia. Tl-201 redistribution was noted in 38 patients, and 23 of them showed a wall motion abnormality during adenosine infusion. Stepwise discriminant analysis was applied to eight variables that showed significant differences by the univariate analysis between patients with the presence and the absence of adenosine-induced wall motion abnormality: myocardial infarction, anginal pain, ST depression, collateral vessels, Tl-201 redistribution, number of diseased vessels of > or = 75% or 90% stenosis and number of segments with Tl-201 redistribution. The number of diseased vessels with > or = 75% stenosis (F = 43.5, p < 0.0001), ST depression (F = 16.0, p < 0.0002), collateral vessels (F = 11.7, p < 0.001) and Tl-201 redistribution (F = 5.6, p < 0.02) were the statistically significant discriminators relating to adenosine-induced wall motion abnormality. Adenosine-induced myocardial ischemia was related to the number of coronary stenoses, reflecting the presence of severe coronary artery disease, and well-developed collaterals that might be integral factors in a coronary steal phenomenon.