Specificity of the stress electrocardiogram during adenosine myocardial perfusion imaging in patients taking digoxin

Am Heart J. 2000 Dec;140(6):937-40. doi: 10.1067/mhj.2000.110937.


Background: In patients taking digoxin, the exercise electrocardiogram has a lower specificity for detecting coronary artery disease. However, the effect of digoxin on adenosine-induced ST-segment depression is unknown. The purpose of this study was to evaluate the specificity of the electrocardiogram during adenosine myocardial perfusion imaging in patients taking digoxin.

Methods: Between May 1991 and September 1997, patients (n = 99) taking digoxin who underwent adenosine stress imaging with thallium-201 or technetium-99m sestamibi and coronary angiography within 3 months were retrospectively identified. Exclusion criteria included prior myocardial infarction, coronary artery angioplasty or bypass surgery, left bundle branch block, paced ventricular rhythm, or significant valvular disease. Twelve-lead electrocardiograms were visually interpreted at baseline, during adenosine infusion, and during the recovery period. The stress electrocardiogram was considered positive if there was > or =1 mm additional horizontal or downsloping ST-segment depression or elevation 0.08 seconds after the J-point compared with the baseline tracing.

Results: ST-segment depression and/or elevation occurred in 24 of 99 patients. There were only 2 false-positive stress electrocardiograms, yielding a specificity of 87% and positive predictive value of 92%. All 8 patients with > or =2 mm ST segment depression had multivessel disease by coronary angiography.

Conclusions: ST-segment depression or elevation during adenosine myocardial perfusion imaging in patients taking digoxin is highly specific for coronary artery disease. Marked (> or =2 mm) ST-segment depression and/or ST-segment elevation is associated with a high likelihood of multivessel disease.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adenosine* / administration & dosage
  • Aged
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / drug therapy
  • Cardiotonic Agents / therapeutic use*
  • Coronary Disease / complications
  • Coronary Disease / diagnosis*
  • Coronary Disease / physiopathology
  • Diagnosis, Differential
  • Digoxin / therapeutic use*
  • Electrocardiography, Ambulatory / drug effects
  • Electrocardiography, Ambulatory / methods*
  • Exercise Test
  • Female
  • Heart Failure / complications
  • Heart Failure / drug therapy
  • Humans
  • Infusions, Intravenous
  • Male
  • Radionuclide Ventriculography*
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Vasodilator Agents* / administration & dosage


  • Cardiotonic Agents
  • Vasodilator Agents
  • Digoxin
  • Adenosine