Dose and test for dipyridamole infusion and cardiac imaging early after uncomplicated acute myocardial infarction

Casanova, R; Patroncini, A; Guidalotti, Pier Luigi; Capacci, Pier Franco; Jacopi, F; Fabbri, Mauro; Maresta, A

doi:10.1016/0002-9149(92)90289-b

Cited by 23 publications

(4 citation statements)

References 26 publications

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“…20,21 An adequate hypotensive response develops with the dose used in our study, probably from the heavy sedation that is known to reduce sympathetic reflexes that might otherwise counter hypotension in the awake situation. Not unexpectedly, therefore, high-dose dipyridamole caused a dramatic systemic pressure drop in our preliminary studies.…”

Section: Limitations Of the Studymentioning

confidence: 85%

Mechanism of Inducible Regional Dysfunction During Dipyridamole Stress

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Pelberg

et al. 2002

Circulation

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Background-We hypothesized that increased myocardial oxygen demand resulting from hypotension and reflex tachycardia unmasking a reduced endocardial myocardial blood flow (MBF) reserve is the mechanism of dipyridamole-induced regional dysfunction in chronic coronary artery disease. Methods and Results-Ameroid constrictors were placed around the proximal coronary arteries and their major branches in 15 dogs to create chronic coronary stenosis. Seven days later, radiolabeled microsphere-derived MBF and 2-dimensional echocardiography-derived percent wall thickening (%WT) were measured at rest and after 0.56 mg/kg dipyridamole. Dipyridamole caused an increase (mean, 21%) in the rate-pressure product secondary to reflex tachycardia resulting from mild systemic hypotension. %WT in myocardial segments with an endocardial MBF reserve (dipyridamole/resting MBF) of 1.5 to 2.5 (nϭ35) did not change after dipyridamole, whereas it decreased in segments with an endocardial MBF reserve of Ͻ1.5 (nϭ30) and increased in those with an endocardial MBF reserve of Ն2.5 (nϭ45) (PϽ0.05). Most (80%) segments with endocardial MBF reserve of Ͻ1.5 and 14% with an endocardial MBF reserve of 1.5 to 2.5 showed inducible dysfunction after dipyridamole, whereas none of the segments with an endocardial MBF reserve of Ն2.

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Section: Limitations Of the Studymentioning

confidence: 85%

Mechanism of Inducible Regional Dysfunction During Dipyridamole Stress

Bin

Pelberg

et al. 2002

Circulation

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“…[13][14][15][16][17] Dagianti, et al and Casanova, et al showed that the sensitivity of dipyridamole stress echocardiography was 52% and 53%, respectively. 18,19) However, the specificity of dipyridamole echocardiography has been reported to be excellent even in challenging subsets of patients in whom the rate of false-positive responses was higher with electrocardiographic or scintigraphic techniques, such as hypertensive patients. 20) In a pooled analysis of data from 11 published series, the sensitivity and specificity of dipyridamole scintigraphy for CAD detection averaged 85% and 90%, respectively.…”

Section: A B Discussionmentioning

confidence: 99%

<b>Dipyridamole Stress Echocardiography and Ultrasonic Myocardial Tissue Characterization in Predicting Myocardial Ischemia, in Comparison With Dipyridamole Stress Tc-99m MIBI SPECT Myocardial Imaging</b>

et al. 2004

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SUMMARYThe purpose of this study was to validate whether dipyridamole stress ultrasonic tissue characterization with cyclic variation of integrated backscatter (CVIBS) compared with dipyridamole stress echocardiography and dipyridamole stress Tc99m-MIBI SPECT myocardial perfusion scintigraphy could predict myocardial ischemia in patients with chronic coronary artery disease.Twenty patients (16 M, 4 F) who had coronary angiography for stable angina pectoris were included in the study. Mean age was 62 ± 8 years. The left ventricle was divided into 16 segments. Regional wall motion analysis and CVIBS measurements were obtained from 16 myocardial segments at rest and after dipyridamole (0.84 mg/kg) infusion. After 10 minutes, Tc-99m MIBI (10 mCi) was injected and SPECT myocardial imaging was performed. After 3 hours, 25 mCi Tc-99m MIBI was reinjected and rest images were obtained.A total of 320 ventricular wall segments were evaluated. Two hundred and six ventricular wall segments were supplied by stenotic coronary arteries and 114 segments were supplied by normal coronary arteries. Dipyridamole stress Tc-99m MIBI SPECT studies showed abnormal myocardial perfusion in 176 segments and normal perfusion in 144 segments. Transient regional wall motion abnormality was detected in 116 segments. A significant decrease in CVIBS after dipyridamole stress was detected in 184 segments. The sensitivity and specificity of dipyridamole stress echocardiography, Tc-99m MIBI SPECT, and CVIBS were 56% and 100%, 85% and 92%, and 89% and 100%, respectively, compared with the results from coronary angiography.Dipyridamole stress ultrasonic tissue characterization with CVIBS may provide more sensitive detection of myocardial ischemia than dipyridamole stress echocardiography and may be as valuable as dipyridamole stress myocardial perfusion scintigraphy. (Jpn Heart J 2004; 45: 937-948)

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“…These results are not surprising, since vasodilators primarily create blood flow heterogeneity (detected by perfusion scintigraphy and not echocardiography) and true myocardial ischaemic (detected by echocardiography) in only a limited number of patients. Of note, not all studies [20] used optimal doses of vasodilator to induce true myocardial ischaemia [33] , and no single comparative study used the new, promising dipyridamole-atropine protocol 34] .…”

Section: Vasodilator Stress Echocardiography Versus Perfusion Scintigraphymentioning

confidence: 99%

“…As described, stress echocardiography has some relative strengths and limitations For the moment stress echocardiography (in particular when vasodilators are used) seems somewhat less sensitive to detecting and localizing (mild) CAD, but seems the more specific test. These findings may partly be explained by the relative low stressor dose used in some studies [8,20] , since it is well known that stress echocardiography is more vulnerable to submaximal stress [33,68,69] . However, it should also be noted that many scintigraphic studies were not performed with the newest technetium-99m SPECT technology.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%