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Okabe Y, Otowa K, Mitamura Y, Murai H, Usui S, Kaneko S, Takamura M. Evaluation of the risk factors for ventricular arrhythmias secondary to QT prolongation induced by papaverine injection during coronary flow reserve studies using a 4 Fr angio-catheter. Heart Vessels 2018; 33:1358-1364. [PMID: 29713819 DOI: 10.1007/s00380-018-1175-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
Estimation of the fractional flow reserve (FFR) is considered to be an established method by which to assess stable coronary artery stenosis. Induction of maximal coronary hyperemia is important during the FFR procedure. Papaverine has been reported to increase the risk of ventricular arrhythmia (VA). The purpose of the present study was to discover predictors of papaverine-induced VAs developing during FFR measurement. A total of 213 clinically stable patients were included in the study. FFRs were determined after intracoronary papaverine administration (12 mg into the left and 8 mg into the right coronary arteries). We compared patients in whom VA did and did not develop in terms of clinical and electrocardiogram characteristics. FFR measurements were performed on 244 lesions (133 in the left anterior descending arteries, 43 in the left circumflex arteries, and 68 in the right coronary arteries). We found that the QTc interval was prolonged in all patients after papaverine administration (average post-administration QTc interval = 569 ± 89 ms; average ΔQTc interval = 144 ± 80 ms). VA developed in three patients with significantly prolonged QT intervals (average post-administration QTc interval = 639 ± 19 ms, average ΔQTc interval = 220 ± 64 ms, p < 0.02) and transitioned from torsade de pointes to ventricular fibrillation. Bradycardia (< 50 beats/min), hypokalemia (serum K < 3.5 mEp/L), and low left ventricular function (ejection fraction (EF) < 50%) were associated with VA (bradycardia, p < 0.01; hypokalemia, p < 0.01; low left ventricular function, p < 0.01). Three-vessel disease was significantly predictive of VA (p < 0.003). In the three-vessel group, the complications of low left ventricular function, hypokalemia, and bradycardia were significantly associated with VA (p < 0.045). Three-vessel disease is a predictor of the development of VA during FFR measurement performed with the aid of papaverine, especially if accompanied by one or more of the following: low left ventricular function, hypokalemia, or bradycardia.
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Affiliation(s)
- Yoshitaka Okabe
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Kanichi Otowa
- Municipal Tsuruga Hospital, 6-60, 1-chome Mishima cho, Tsuruga, Fukui, Japan
| | - Yasuhito Mitamura
- Municipal Tsuruga Hospital, 6-60, 1-chome Mishima cho, Tsuruga, Fukui, Japan
| | - Hisayoshi Murai
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Soichiro Usui
- Municipal Tsuruga Hospital, 6-60, 1-chome Mishima cho, Tsuruga, Fukui, Japan
| | - Shuichi Kaneko
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Masayuki Takamura
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Nakayama M, Hirano M, Goto S, Watanabe A, Uchiyama T. Coronary arterial spasm detected by coronary computed tomography angiography and confirmed by intravascular ultrasound. Radiol Case Rep 2018; 13:14-17. [PMID: 29552237 PMCID: PMC5850873 DOI: 10.1016/j.radcr.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/21/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
A 40-year-old man was admitted to our hospital for chest pain after smoking. Coronary computed tomography angiography showed severe stenosis in the left anterior descending artery. The stenosis site had no plaque on stretched curved multiplanar reconstruction and short-axis images. Coronary angiography revealed improvement of the severe stenosis after the intracoronary administration of isosorbide dinitrate in the left anterior descending artery. Intravascular ultrasound demonstrated negative remodeling without a plaque and diffuse intima with media thickening at the stenosis site. The chest pain was likely caused by coronary spastic angina, which was treated with diltiazem hydrochloride.
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Affiliation(s)
- Masafumi Nakayama
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
- Corresponding author.
| | - Masaharu Hirano
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Sonoka Goto
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Akifumi Watanabe
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Takashi Uchiyama
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
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Nam JG, Choi SH, Kang BS, Bang MS, Kwon WJ. Development of Coronary Vasospasm during Adenosine-Stress Myocardial Perfusion CT Imaging. Korean J Radiol 2015; 16:673-7. [PMID: 25995700 PMCID: PMC4436000 DOI: 10.3348/kjr.2015.16.3.673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/19/2015] [Indexed: 11/15/2022] Open
Abstract
Adenosine is a short-acting coronary vasodilator, and it is widely used during pharmacological stress myocardial perfusion imaging. It has a well-established safety profile, and most of its side effects are known to be mild and transient. Until now, coronary vasospasm has been rarely reported as a side effect of adenosine during or after adenosine stress test. This study reports a case of coronary vasospasm which was documented on stress myocardial perfusion CT imaging during adenosine stress test.
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Affiliation(s)
- Jeong Gu Nam
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Seong Hoon Choi
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Byeong Seong Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Min Seo Bang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Woon Jeong Kwon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
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Nakayama M, Tanaka N, Sakoda K, Hokama Y, Hoshino K, Kimura Y, Ogawa M, Yamashita J, Kobori Y, Uchiyama T, Aizawa Y, Yamashina A. Papaverine-induced polymorphic ventricular tachycardia during coronary flow reserve study of patients with moderate coronary artery disease. Circ J 2015; 79:530-6. [PMID: 25746536 DOI: 10.1253/circj.cj-14-1118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Papaverine is useful for evaluating the functional status of a coronary artery, but it may provoke malignant ventricular arrhythmia (VA). The aim of this study was to investigate the incidence, and clinical and ECG characteristics of patients with papaverine-induced VAs. METHODS AND RESULTS: The 182 consecutive patients underwent fractional flow reserve (FFR) measurement of 277 lesions. FFR was determined after intracoronary papaverine administration by standard procedures. The clinical and ECG characteristics were compared between patients with and without ventricular tachycardia (VT: ≥3 successive premature ventricular beats (PVBs), or ventricular fibrillation (VF)). After papaverine administration, the QTc interval, QTUc interval, and T-peak to U-end interval were prolonged significantly. Single PVBs on the T-wave or U-wave type developed in 29 patients (15.9%). Polymorphic VT (torsade de pointes) occurred in 5 patients (2.8%), and of those, VF developed in 3 patients (1.7%). No clinical and baseline ECG parameters were predictors for VT or VF except for sex and administration of papaverine into the left coronary artery. Excessive prolongation of QT (or QTU), T-peak to U-end intervals and giant T-U waves were found immediately prior to the ventricular tachyarrhythmias (VTAs), which were unpredictable from the baseline data. CONCLUSIONS Intracoronary administration of papaverine induced fatal VTAs, although the incidence is rare. Excessive prolongation of the QT (and QTU) interval appeared prior to VTAs; however, they were unpredictable.
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Affiliation(s)
- Masafumi Nakayama
- Department of Cardiology, Tokyo Medical University; Cardiovascular Center, Toda Central General Hospital, Saitama, Japan.
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Matsumoto N, Nagao K, Hirayama A, Kasama S. Adenosine-induced coronary vasospasm following drug-eluting stent implantation. BMJ Case Rep 2014; 2014:bcr-2013-202996. [PMID: 24518394 DOI: 10.1136/bcr-2013-202996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of coronary vasospasm during adenosine stress in a patient with a prior drug-eluting stent implantation. The patient had a stent implantation in the left anterior descending coronary artery 3 years ago. Recently, he developed a chest pain and underwent adenosine stress myocardial perfusion single photon emission CT (SPECT). During the adenosine stress, he felt severe chest pain and ST elevation on electrocardiogram. An invasive coronary angiography showed no in-stent restenosis. This phenomenon deemed to be adenosine-induced coronary vasospasm after stent implantation.
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Affiliation(s)
- Naoya Matsumoto
- Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan
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Coronary vasospasm while treating supraventricular tachycardia: is adenosine really to blame? Case Rep Cardiol 2013; 2013:897813. [PMID: 24826297 PMCID: PMC4008346 DOI: 10.1155/2013/897813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/19/2013] [Indexed: 11/20/2022] Open
Abstract
Coronary artery spasm has been reported during adenosine stress testing. Herein, we describe a transient ST-segment elevation following adenosine therapy for supraventricular tachycardia. A 38-year-old male presented to the emergency department with palpitations. Electrocardiogram showed supraventricular tachycardia with short RP interval. Vagal maneuvers were unsuccessful. Adenosine was then administered in two successive injections of 6 and 12 mg dosages, respectively. A subsequent 12-lead electrocardiogram revealed ST-segment elevation in inferior leads with reciprocal changes. Coronary angiography disclosed nonobstructive coronary disease. A postprocedure electrocardiogram exhibited normal sinus rhythm with nonspecific T wave abnormalities. Cardiac biomarkers were elevated with a peak troponin I of 0.32. Echocardiogram depicted bicuspid aortic valve and normal systolic function. Electrophysiological study revealed a concealed left accessory pathway and successful radiofrequency ablation was performed. Given the dynamic changes in the electrocardiogram, we hypothesize that this event was most likely a coronary vasospasm. The mechanism of coronary spasm following adenosine injection remains uncertain. Potential mediators include KATP channels and adenosine-2 receptors.
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Ismail M, Asaad N, Al-Suwaidi J. Adenosine-induced coronary artery spasm: a case report. Med Princ Pract 2012; 21:82-5. [PMID: 22024961 DOI: 10.1159/000331809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 04/14/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe an uncommon complication of intravenous adenosine administration. CLINICAL PRESENTATION AND INTERVENTION A 41-year-old female patient presented with palpitations due to supraventricular tachycardia. The patient was treated with intravenous adenosine with resolution of the tachycardia. Subsequently, the patient developed chest pain and ST segment elevation in the inferior leads that resolved with sublingual nitroglycerin. CONCLUSION This report showed a case of coronary spasm secondary to the administration of adenosine. We therefore recommend that discretion be exercised when giving adenosine, especially to patients with an underlying tendency for vasospastic reactions.
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Affiliation(s)
- Montaser Ismail
- Department of Cardiology and Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
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Han PP, Tian YQ, Wei HX, Wang Q, He ZX. Coronary spasm after completion of adenosine pharmacologic stress test. Ann Nucl Med 2011; 25:580-5. [PMID: 21573869 DOI: 10.1007/s12149-011-0493-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 04/06/2011] [Indexed: 11/30/2022]
Abstract
Adenosine is a frequently used pharmacologic stress agent in myocardial perfusion imaging. Its safety profile is well established, and most of its side effects are mild and transient. Coronary vasospasm occurs occasionally during or after adenosine stress test in rare cases, which may lead to seriously adverse outcomes. This study reported 3 such cases after completion of adenosine pharmacologic stress test.
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Affiliation(s)
- Ping-Ping Han
- Department of Nuclear Medicine, Cardiovascular Institute, Chinese Academy of Medical Sciences, 167 Bei Li Shi Lu, Beijing, 100037, China.
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Xiang D, Xie Z, Zhang J, Yin J. Investigation of the mechanism of reverse redistribution in thallium-201 myocardial perfusion scintigraphy in patients with suspicion for coronary artery spasm. J Nucl Cardiol 2011; 18:314-23. [PMID: 21328028 DOI: 10.1007/s12350-011-9342-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 01/11/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reverse redistribution (RR) is one of the features on myocardial perfusion scintigraphy (MPS) in patients with coronary artery spasm (CAS). This study was aimed to explore the mechanism of RR in patients with suspicion for CAS. METHODS AND RESULTS Thirty patients with RR and suspicion for CAS but without coronary artery stenosis (RR group) and 32 control patients without RR (control group) underwent coronary angiography before and after a dipyridamole administration. Coronary blood flow velocity and myocardial perfusion, as determined by corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) and TIMI myocardial perfusion grade (TMPG), were measured. Coronary angiography showed significantly slower blood flow velocity [CTFC (37 ± 6) frame vs (29 ± 7) frame, P < .01] and lower myocardial perfusion [TMPG (2.08 ± 0.38) grade vs (2.55 ± 0.33) grade, P < .05] in RR-related arteries than in RR-unrelated arteries in the RR group. But, there was no significant difference among different coronary artery branches in the control group. After the injection of dipyridamole, CTFC decreased and TMPG increased in the RR group. The decline in CTFC and the increase in TMPG in RR-related arteries were more significant than those in RR-unrelated ones (28% vs 14% and 45% vs 16%, respectively; both P < .01). The endothelin-1/nitric oxide (NO) ratio was significantly higher in the RR group than in the control group before the injection of dipyridamole (2.79 ± 0.37 vs 1.70 ± 0.19, P < .01). After the injection of dipyridamole, the ratio went down in both groups, but the decline was statistically significant in the RR group (2.42 ± 0.33, P < .05) but not in the control group (1.42 ± 0.19, P < .05). Pearson correlation analysis showed that there was a positive correlation between summed rest scores on MPS and the endothelin-1/NO ratio (r = 0.853, P = .000) as well as CTFC (r = 0.808, P = .000) before the injection of dipyridamole in the RR group. CONCLUSION Patients with suspicion for CAS may exhibit a mild spasm of RR-related arteries and corresponding microvasculature and a significant imbalance of coronary blood flow velocity and myocardial perfusion at rest between RR-related and RR-unrelated areas. This is overcome by stress-induced hyperemic flow increases and which may account for RR on MPS.
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Affiliation(s)
- Dingcheng Xiang
- Department of Cardiology, Liuhuaqiao Hospital, 111# Liuhua Road, Guangzhou 510010, China.
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Jevon P, Hodgkins L. Nurse-led pharmacological stress testing: an overview. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2010; 19:569-574. [PMID: 20505580 DOI: 10.12968/bjon.2010.19.9.48056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Myocardial perfusion imaging (MPI) is a noninvasive diagnostic tool that can provide valuable information on coronary blood flow at rest and during stress. Dynamic exercise is the stress technique of choice with patients who can achieve an acceptable workload; for those unable to do so, pharmacological stress testing with adenosine or dobutamine can be used. Nurses trained in ECG interpretation and advanced resuscitation skills are increasingly involved in supervising pharmacological stress tests. This article provides an overview of nurse-led pharmacological stress testing.
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