With the technical assistance of Ezio M. Ferdeghini, PhD Seventy-four consecutive patients with angina undergoing single-lesion percutaneous transluminal coronary angioplasty were evaluated with high-dose (up to 0.84 mg/kg during 10 minutes) dipyridamole echocardiography test (DET) before angioplasty and when possible, afterward. Angioplasty was clinically or angiographically successful in 63 patients and unsuccessful in 11. Before the procedure, 69 patients had a positive DET. Of these 69 patients, six with clinically unsuccessful angioplasty had a dipyridamole time (i.e., the time from the onset of dipyridamole infusion to development of asynergy) lower than the 63 patients with clinically successful angioplasty (4.2 ±2.9 vs. 7.0+2.9 minutes, mean± SD, p<0.01). In the five patients with angiographically unsuccessful angioplasty (residual stenosis diameter, >50%), coronary stenosis decreased from 89+10 to 69+22 (p=NS); DET was positive in all five before and in four of the five after the procedure (100% vs. 80%o, p=NS). In the 63 patients with angiographically successful angioplasty, coronary stenosis diameter was reduced from 85±9% to 30+10% (p<0.01). DET was positive in 58 patients before and in only 16 after the procedure (92% vs. 25%, p<0.01). In the 16 patients with positive DET, before and after angioplasty, dipyridamole time increased from 5.6±2.2 before to 7.3+±2.4 minutes immediately after the procedure (p<0.05). After an average follow-up time of 10.8±5.9 months, angina recurred in eight of 47 patients with negative DET after angioplasty and in 11 of 16 patients with positive DET (17% vs. 69%, p< 0.01). When angina symptoms recurred, a third DET was performed 1-3 days before repeat coronary angiography in 11 patients (3.6±2.7 months after the angioplasty). DET was positive in 10 of these patients, and all had coronary restenosis at angiography. DET was negative in the remaining patient, and this patient had no restenosis at angiography. These findings show that 1) before angioplasty, DET positivity with a very low dipyridamole time identifies a subset of patients at relatively higher risk of an unsuccessful procedure, 2) there is an excellent general correlation between the functional improvement assessed by DET and anatomic results of angioplasty, 3) DET positivity soon after successful angioplasty identifies a group at high risk for later recurrence of symptoms, and 4) when symptoms recur after angioplasty, DET positivity reliably identifies coronary restenosis. (Circulation 1989;80:807-815

The purpose of the present study was to determine the value of exercise testing (ET) and dipyridamole echocardiography test (DET) in the early functional evaluation after a successful coronary angioplasty (PTCA) and in the prediction of angina recurrence. 52 patients underwent ET and DET before and 48 h after a successful PTCA. During a 6-12 month follow-up period they all underwent clinical evaluation. Before PTCA, ET was positive in 49 of 52 patients (94%) and new asynergies were detected by DET in 47 of 52 patients (90%). 48 h after PTCA 23 patients (44%) had positive ET results and 10 had a positive DET response. During the follow-up, 17 patients experienced recurrence of angina. Positive predictive value (PPV) for angina recurrence of ET and DET performed early after the PTCA were, respectively, 57 and 80%. The PPV of ET increased to 88% when electrocardiographic (ECG) positivity was accompanied by angina. Negative predictive values of ET and DET were, respectively, 86% and 79%. Early after PTCA, exercise ECG positivity was not predictive of symptom recurrence while ECG positivity associated with angina revealed a high PPV, similar to that of DET.

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