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. 1992 Feb;67(2):144–149. doi: 10.1136/hrt.67.2.144

Uses and limitations of high dose dipyridamole stress echocardiography for evaluation of coronary artery disease.

P Mazeika 1, P Nihoyannopoulos 1, J Joshi 1, C M Oakley 1
PMCID: PMC1024744  PMID: 1540434

Abstract

OBJECTIVE--To compare the usefulness of high dose dipyridamole stress echocardiography with dipyridamole stress electrocardiography and exercise electrocardiography for the evaluation of coronary artery disease. DESIGN--Prospective investigation with coronary angiography as the criterion standard and blinded assessment of study data. SETTING--Cardiology unit of a tertiary referral centre. SUBJECTS--Fifty eight patients with suspected coronary disease; three of these were excluded because of poor echogenicity at baseline (test feasibility 95%). Angiography showed normal coronary arteries in 15 and coronary disease (greater than or equal to 70% diameter stenosis) in 40. INTERVENTIONS--Cross sectional echocardiography and 12 lead electrocardiography during dipyridamole stress (up to 1 mg/kg) and exercise electrocardiography on a separate occasion. Wall motion was analysed with an 11-segment model developed at Hammersmith Hospital. MAIN OUTCOME MEASURES--Test sensitivity, specificity, and side effect data. RESULTS--16 of 40 patients with coronary artery disease had inducible asynergy; all had multivessel disease and a tight stenosis in the vessel that supplied the abnormal segment. Exercise duration and time to 1 mm ST segment depression were significantly shorter in patients with a positive echocardiogram than in those without (both p less than 0.01). The sensitivity and specificity of dipyridamole stress echocardiography were 40% and 93% respectively; sensitivity improved to 60% when baseline (n = 18) or reversible asynergy defined an abnormal study (likelihood ratio = 9). Corresponding figures for stress electrocardiography were 38% and 80% for dipyridamole and 80% and 67% for exercise. Adverse reactions were seen in 67% of patients and included two instances of pronounced hypotension, one episode of prolonged myocardial ischaemia, and one cardiac arrest in a patient who was successfully resuscitated. CONCLUSION--A positive high dose dipyridamole echocardiogram predicts multivessel disease and impaired coronary reserve, but low overall sensitivity and occasionally troublesome side effects limit its clinical usefulness.

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Selected References

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  1. Bayliss J., Pearson M., Sutton G. C. Ventricular dysrhythmias following intravenous dipyridamole during "stress" myocardial imaging. Br J Radiol. 1983 Sep;56(669):686–686. doi: 10.1259/0007-1285-56-669-686. [DOI] [PubMed] [Google Scholar]
  2. Blumenthal M. S., McCauley C. S. Cardiac arrest during dipyridamole imaging. Chest. 1988 May;93(5):1103–1104. doi: 10.1378/chest.93.5.1103. [DOI] [PubMed] [Google Scholar]
  3. Bruce R. A., Kusumi F., Hosmer D. Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am Heart J. 1973 Apr;85(4):546–562. doi: 10.1016/0002-8703(73)90502-4. [DOI] [PubMed] [Google Scholar]
  4. Cohen J. L., Greene T. O., Alston J. R., Wilchfort S. D., Kim C. S. Usefulness of oral dipyridamole digital echocardiography for detecting coronary artery disease. Am J Cardiol. 1989 Aug 1;64(5):385–386. doi: 10.1016/0002-9149(89)90540-7. [DOI] [PubMed] [Google Scholar]
  5. Friedman H. Z., Goldberg S. F., Hauser A. M., O'Neill W. W. Death with dipyridamole-thallium imaging. Ann Intern Med. 1988 Dec 15;109(12):990–991. doi: 10.7326/0003-4819-109-12-990. [DOI] [PubMed] [Google Scholar]
  6. Fung A. Y., Gallagher K. P., Buda A. J. The physiologic basis of dobutamine as compared with dipyridamole stress interventions in the assessment of critical coronary stenosis. Circulation. 1987 Oct;76(4):943–951. doi: 10.1161/01.cir.76.4.943. [DOI] [PubMed] [Google Scholar]
  7. Homma S., Gilliland Y., Guiney T. E., Strauss H. W., Boucher C. A. Safety of intravenous dipyridamole for stress testing with thallium imaging. Am J Cardiol. 1987 Jan 1;59(1):152–154. doi: 10.1016/s0002-9149(87)80089-9. [DOI] [PubMed] [Google Scholar]
  8. Iskandrian A. S., Heo J., Askenase A., Segal B. L., Auerbach N. Dipyridamole cardiac imaging. Am Heart J. 1988 Feb;115(2):432–443. doi: 10.1016/0002-8703(88)90492-9. [DOI] [PubMed] [Google Scholar]
  9. Kern M. J., Pearson A. C., Labovitz A. J., Deligonul U., Vandormael M., Gudipati C. Effects of pharmacologic coronary hyperemia on echocardiographic left ventricular function in patients with single vessel coronary artery disease. J Am Coll Cardiol. 1989 Apr;13(5):1042–1051. doi: 10.1016/0735-1097(89)90259-3. [DOI] [PubMed] [Google Scholar]
  10. Lewen M. K., Labovitz A. J., Kern M. J., Chaitman B. R. Prolonged myocardial ischemia after intravenous dipyridamole thallium imaging. Chest. 1987 Dec;92(6):1102–1104. doi: 10.1378/chest.92.6.1102. [DOI] [PubMed] [Google Scholar]
  11. Margonato A., Chierchia S., Cianflone D., Smith G., Crea F., Davies G. J., Maseri A., Foale R. A. Limitations of dipyridamole-echocardiography in effort angina pectoris. Am J Cardiol. 1987 Feb 1;59(4):225–230. doi: 10.1016/0002-9149(87)90789-2. [DOI] [PubMed] [Google Scholar]
  12. Picano E. Dipyridamole-echocardiography test: historical background and physiologic basis. Eur Heart J. 1989 Apr;10(4):365–376. doi: 10.1093/oxfordjournals.eurheartj.a059494. [DOI] [PubMed] [Google Scholar]
  13. Picano E., Lattanzi F., Masini M., Distante A., L'Abbate A. Comparison of the high-dose dipyridamole-echocardiography test and exercise two-dimensional echocardiography for diagnosis of coronary artery disease. Am J Cardiol. 1987 Mar 1;59(6):539–542. doi: 10.1016/0002-9149(87)91165-9. [DOI] [PubMed] [Google Scholar]
  14. Sawada S. G., Ryan T., Fineberg N. S., Armstrong W. F., Judson W. E., McHenry P. L., Feigenbaum H. Exercise echocardiographic detection of coronary artery disease in women. J Am Coll Cardiol. 1989 Nov 15;14(6):1440–1447. doi: 10.1016/0735-1097(89)90378-1. [DOI] [PubMed] [Google Scholar]
  15. Stratmann H. G., Kennedy H. L. Evaluation of coronary artery disease in the patient unable to exercise: alternatives to exercise stress testing. Am Heart J. 1989 Jun;117(6):1344–1365. doi: 10.1016/0002-8703(89)90417-1. [DOI] [PubMed] [Google Scholar]
  16. Verani M. S., Mahmarian J. J., Hixson J. B., Boyce T. M., Staudacher R. A. Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise. Circulation. 1990 Jul;82(1):80–87. doi: 10.1161/01.cir.82.1.80. [DOI] [PubMed] [Google Scholar]
  17. Younis L. T., Chaitman B. R. Update on intravenous dipyridamole cardiac imaging in the assessment of ischemic heart disease. Clin Cardiol. 1990 Jan;13(1):3–10. doi: 10.1002/clc.4960130103. [DOI] [PubMed] [Google Scholar]

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