A flow-limiting stenosis is the major determinant of exercise-induced myocardial stunning in patients with coronary artery disease

Tanaka, Hirokazu; Chikamori, Taishiro; Tanaka, Nobuhiro; Hida, Satoshi; Shindo, Naohisa; Igarashi, Yuko; Yamashina, Akira

doi:10.1016/j.jjcc.2009.12.012

Cited by 7 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The number of the patients who developed VTAs during the FFR study was small, but as common ECG findings, VTAs are often associated with excessive QTU prolongation or giant T-U waves (6)(7)(8)(9)(10)(11)(12)(13). VTAs occurred more often in our FFR study than that of earlier workers (7-16) however the exact reason was not clarified.…”

Section: Limitationmentioning

confidence: 63%

“…To induce maximal hyperemia, adenosine, adenosinetriphosphate (ATP) or papaverine have been used (4,6,7). Papaverine hydrochloride is easy to administer intracoronary and results in a steady-state of hyperemia of durations up to 15 sec, however this drug may provoke ventricular tachyarrhythmias (VTAs) (6,(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…Papaverine hydrochloride is easy to administer intracoronary and results in a steady-state of hyperemia of durations up to 15 sec, however this drug may provoke ventricular tachyarrhythmias (VTAs) (6,(8)(9)(10)(11)(12)(13). Recently we encountered 4 patients in which VTAs developed during the FFR study and predictors of VTAs were analyzed from the clinical and ECG findings.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Papaverine-Induced Polymorphic Ventricular Tachycardia in Relation to QTU and Giant T-U Waves in Four Cases

et al. 2012

Self Cite

View full text Add to dashboard Cite

Objective Papaverine is used for the evaluation of functional status of the coronary arteries but it may provoke severe ventricular tachyarrhythmias (VTAs). This study compared the clinical and ECG characteristic of patients with papaverine-induced VTAs. Materials and MethodsThe study involved 25 patients who underwent a fractional flow reserve (FFR) study. FFR was determined as the ratio of blood pressure at the distal and the proximal site of stenosis after intracoronary papaverine administration at 12 mg into the left and 8 mg into the right coronary artery. The QT and QTU intervals were measured manually in the limb leads and in the precordial leads, respectively and corrected by the R-R interval to obtain QTc and QTUc. The clinical and ECG data were compared between the patient groups with and without VTAs. Results After papaverine administration into the left (20), right (3) or both coronary arteries (2), the RR interval shortened, but non-significantly however, the QT interval (and QTc) and the QTU interval (and QTUc) were significantly prolonged. VTAs developed in four women: torsade de pointes in 3 followed by ventricular fibrillation and ventricular premature beats in 1 patient. After papaverine administration, QTU and QTUc were more prolonged in women than men and in patients with VTAs compared to those without. Just prior to VTAs, giant T-U waves were observed. Conclusion Intracoronary papaverine was used to determine FFR which may induce VTAs. VTAs developed only in women and they were closely related to prolongation of the QTU intervals with prominent T-U waves.

show abstract

Section: Limitationmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Papaverine-Induced Polymorphic Ventricular Tachycardia in Relation to QTU and Giant T-U Waves in Four Cases

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the present patient, we employed papaver-ine hydrochloride for the FFR study because it can be administered intracoronary and induces a relatively steady-state of maximal hyperemia (3,4).…”

Section: Discussionmentioning

confidence: 99%

“…FFR <0.80 was considered to be an indication for coronary intervention therapy. We administered papaverine hydrochloride to induce the maximal dilatation: 12 mg was administered into LAD in 15 seconds, and FFR was determined at the end of administration (3,4). The patient's baseline ECG was normal ( Fig.…”

mentioning

confidence: 99%

Papaverine-induced QT Interval Prolongation and Ventricular Fibrillation in a Patient with a History of Drug-induced QT Prolongation

et al. 2014

View full text Add to dashboard Cite

A 64-year-old woman underwent a coronary flow reserve evaluation using intracoronary-administered papaverine into the left anterior descending artery. Her baseline electrocardiogram (ECG) was normal, but toward the end of papaverine administration, the QTU intervals were excessively prolonged and torsade de pointes occurred, leading to ventricular fibrillation. Ten months previously, the patient's ECG showed mildly prolonged QTc (480 ms 1/2 ), which normalized after the cessation of bepridil. This case report suggests that a history of drug-induced QT prolongation can be a risk factor for papaverine-induced fatal ventricular arrhythmia. Case ReportWe herein describe a case of a 64-year-old woman who had been treated for hypertension and paroxysmal atrial fibrillation. Ten months previously, she had developed chest pain and cold sweats and was transferred to our hospital. Upon admission, her electrocardiogram (ECG) showed mild ST depression in the leads V4-6. Her ECG showed normal sinus rhythm and a normal QT interval of 440 ms, but it showed mildly prolonged QTc (480 ms 1/2 ), which normalized after the cessation of bepridil (100 mg/day), which had been administered for atrial fibrillation (Fig. 1A, B). After providing informed consent, the patient underwent coronary angiography, which revealed 90% stenosis in the right coronary artery, 75% stenosis in the left anterior descending artery (LAD), and 99% stenosis in the left circumflex artery. A drug-eluting stent was placed, and the lesion of the left circumflex artery was dilated to 0% of stenosis. The patient became asymptomatic and was administered antihypertensive drugs (bisoprolol 2.5 mg/d and imidapril 2.5 mg/d) and antiplatelet agents (biaspirin 100 mg/d and clopidogrel 75 mg/d) and followed in the outpatient clinic. The patient was re-admitted for coronary artery re-evaluation. At the time of catheterization, her blood pressure was 113/73 mmHg, and her heart rate was 56 beats/min. Her serum potassium was 4.2 meq/L. No re-stenosis was observed at the stenting site. Then, the stenosis of the LAD was evaluated using the coronary fractional flow reserve (FFR) method (1, 2). Briefly, a pressure wire (Pressure Wire, Radi Medical Systems, Wilmington, USA) was passed through the stenotic lesion, her blood pressure was recorded during a pull-back, and FFR was calculated as the ratio of the mean coronary pressure distal to the stenosis divided by the mean aortic pressure. FFR <0.80 was considered to be an indication for coronary intervention therapy. We administered papaverine hydrochloride to induce the maximal dilatation: 12 mg was administered into LAD in 15 seconds, and FFR was determined at the end of administration (3,4).The patient's baseline ECG was normal ( Fig. 2A), but toward the end of the papaverine administration, the QT and QTU intervals were excessively prolonged, and this was soon followed by torsade de pointes (TdP) and ventricular fibrillation (VF) (Fig. 2B). Her sinus rhythm was resumed Cardiology,

show abstract

A flow-limiting stenosis is the major determinant of exercise-induced myocardial stunning in patients with coronary artery disease

Abstract: The major determinant for exercise-induced myocardial stunning was a severe flow-limiting coronary stenosis, which was more important than anatomical evaluation based on luminal narrowing alone.

Cited by 7 publications

References 19 publications

Papaverine-Induced Polymorphic Ventricular Tachycardia in Relation to QTU and Giant T-U Waves in Four Cases

Papaverine-Induced Polymorphic Ventricular Tachycardia in Relation to QTU and Giant T-U Waves in Four Cases

Papaverine-induced QT Interval Prolongation and Ventricular Fibrillation in a Patient with a History of Drug-induced QT Prolongation

Fractional flow reserve for guidance in intervention of multiple sequential lesions

Contact Info

Product

Resources

About