Practicability and safety of dipyridamole cardiac imaging in patients with severe chronic obstructive pulmonary disease

Abstract

We tested the practicability of dipyridamole myocardial nitrogen-13 ammonia positron emission tomography (dipyridamole (13)NH(3 )PET) for the perioperative risk assessment of coronary artery disease (CAD) in a cohort of patients with severe chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS). Twenty consecutive LVRS candidates, 13 men and 7 women (mean age 57+/-2 years), without symptoms of CAD were prospectively studied by dipyridamole (13)NH(3 )PET. Side-effects and overall tolerance were assessed by a questionnaire and visual analogue scale. Repeated pulmonary function tests were performed before and 4, 12, 16 and 30 minutes after dipyridamole injection. All dipyridamole (13)NH(3 )PET studies were negative for CAD. Seventeen patients underwent LVRS without cardiac complications; three patients did not undergo LVRS for other reasons. Nine patients suffered intolerable dyspnoea requiring i.v. aminophylline. Mean FEV(1) decreased significantly after dipyridamole infusion: in nine patients the reduction in FEV(1)exceeded 15% from baseline. We found that dipyridamole is not well tolerated and causes significant bronchoconstriction in patients with severe COPD. Although all dipyridamole-induced side effects can be promptly reversed by aminophylline, dipyridamole cannot be recommended as a pharmacological stress in this setting.

Cardiac Disease in Chronic Obstructive Pulmonary Disease

“…Noninvasive assessment of coronary disease in COPD is problematic because patients with COPD are often ventilatory limited in exercise, and pharmacologic stress testing (including adenosine and dipyrimadole) may be associated with bronchospasm (76,77). Although a rigorous nurse-directed protocol may allow dipyrimadole testing to be done safely in some patients with COPD, it is not recommended in severe disease (77).…”

The safety and tolerability of adenosine in patients with obstructive airways disease

“…Dipyridamole is thought to act by blocking the reuptake of adenosine, and its safety in patients without airways disease undergoing myocardial perfusion imaging has been established [1,2]. Controversy exists regarding the safety and tolerability of dipyridamole in patients with severe COPD however [3,4], and it is contraindicated in patients with asthma [5].…”

Factors Influencing Non-cardiac Side Effects of Dipyridamole When Used for Myocardial Perfusion Stress Testing

“…In this study, shortness of breath was only reported by one patient (0.8% of the population) which agrees with other studies [13,20,25], which list 2.6% to 4% of the population having this side effect. Indeed, shortness of breath was the major side effect reported by chronic obstructive pulmonary disease patients [27]. At the OCC, dipyridamole stress testing is not performed on patients with asthma or severe chronic obstructive pulmonary disease, which may account for the low number of patients reporting shortness of breath.…”