Circulation, Vol 83, 1256-1262, Copyright © 1991 by American Heart Association
F Lattanzi, E Picano, L Bolognese, C Piccinino, G Sarasso, A Orlandini and A L'Abbate
BACKGROUND. Dipyridamole echocardiography test (DET: two-dimensional
echocardiographic monitoring with dipyridamole infusion up to 0.84 mg/kg in
10 minutes) is a useful tool for the noninvasive diagnosis of coronary
artery disease. Aims of the present study were to assess the effects of
antianginal drugs on dipyridamole-induced ischemia and to evaluate whether
drug-induced changes in DET response may predict variations in exercise
tolerance. METHODS AND RESULTS. Fifty-seven patients with angiographically
assessed significant coronary artery disease (greater than 70% lumen
reduction in at least one major coronary vessel) performed a DET and an
exercise electrocardiography test (EET) in random order both off treatment
and on antianginal drugs (beta-blockers, calcium antagonists and nitrates,
alone or in various combinations). The criterion for DET positivity was a
transient dyssynergy of contraction absent or of a lesser degree in the
baseline examination. In DET, two parameters were evaluated: the
dipyridamole time (i.e., the time from onset of dipyridamole infusion to
obvious dyssynergy) and the wall motion score index. DET sensitivity was
91% off therapy and fell to 65% under therapy (p less than 0.01). In the 37
patients who had a positive DET both off and on therapy, the dipyridamole
time increased from 6 +/- 3 (off therapy) to 8 +/- 3 minutes (on therapy)
(p less than 0.01). The wall motion score index at peak dipyridamole went
from 1.38 +/- 0.14 to 1.31 +/- 0.14 (p less than 0.01). EET and DET yielded
concordant (positive versus negative) results in 41 of 57 (71%) patients
off and in 35 of 57 (61%) on therapy (p = NS). In the subgroup of 38
patients with both positive DET and EET without treatment, the
therapy-induced variations in exercise time were significantly correlated
with the variations in dipyridamole time (r = 0.5; p less than 0.01), not
with variations in wall motion score index (r = 0.3; p = NS). CONCLUSIONS.
1) Antianginal therapy can protect from dipyridamole-induced ischemia and
2) the therapy-induced changes in DET response parallel variations in
exercise tolerance and might be useful for the objective,
exercise-independent assessment of the therapy efficacy.
ARTICLES
Inhibition of dipyridamole-induced ischemia by antianginal therapy in humans. Correlation with exercise electrocardiography
C.N.R. Clinical Physiology Institute, University of Pisa, Italy.
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