Circulation, Vol 89, 753-761, Copyright © 1994 by American Heart Association
E Picano, O Parodi, F Lattanzi, G Sambuceti, MJ Andrade, P Marzullo, A Giorgetti, P Salvadori, M Marzilli and A Distante
BACKGROUND: The aim of this study was to compare the results of
dipyridamole-echocardiography test (DET: two-dimensional echo monitoring
during dipyridamole infusion up to 0.84 mg/kg over a period of 10 minutes)
with both anatomic and physiological parameters of coronary artery disease
severity, assessed by computer-assisted quantitative coronary
arteriography, and regional coronary flow reserve, measured by [13N]ammonia
(13NH3) and dynamic positron emission tomography (PET), respectively.
METHODS AND RESULTS: We studied 31 patients with a history of chest pain
and neither previous myocardial infarction nor resting wall motion
abnormalities. Eighteen patients had single-vessel disease (> 50%
stenosis of one major coronary vessel), and 13 had normal coronary
arteries. The criterion for DET positivity was the appearance of a new
transient regional wall motion abnormality. In patients with a positive
DET, two parameters were evaluated: the dipyridamole time (ie, the time
from the beginning of drug infusion to the development of obvious
dyssynergy) and the wall motion score index (WMSI, a semiquantitative
integrated estimation of extent and severity of the stress-induced
dyssynergy). WMSI was derived by summation of individual segment scores
divided by the number of segments interpreted. Quantification of regional
myocardial blood flow was obtained by PET measurements of 13NH3 arterial
input function and left ventricular myocardial tissue concentration both at
control and after dipyridamole (0.56 mg/kg over 4 minutes). Maximal
regional blood flow after dipyridamole in the region supplied by the
stenotic vessel was significantly lower in the 11 patients with coronary
artery disease and positive DET than in the 7 patients with coronary artery
disease and negative DET (1.08 +/- 0.33 versus 1.98 +/- 0.37 mL.min-1.g-1,
P < .01). In patients with a positive DET, regional coronary flow
reserve correlated well with dipyridamole time (r = .87, P < .01) but
not with peak WMSI (r = .25, P = NS). Patients with dipyridamole-induced
akinesia or dyskinesia (n = 6) had a greater reduction in regional coronary
flow reserve than did those showing hypokinesia (n = 5): 1.38 +/- 0.51
versus 2.17 +/- 0.42, P < .05. Percent area reduction was more severe in
patients with DET positivity than in those with DET negativity (93.7 +/-
8.7% versus 77 +/- 10.3%, P < .01), and it correlated with regional
coronary flow reserve (r = .64, P < .01) and dipyridamole time (r =
-.59, P < .01). CONCLUSIONS: In patients with single-vessel disease, DET
shows an excellent specificity but a limited sensitivity; in these
patients, DET positivity is associated with a physiologically important
coronary stenosis. Severity of the anatomic stenosis and impairment in
regional flow reserve are greater when the dipyridamole-induced dyssynergy
appears earlier during the test. Therefore, a stratification of the
anatomo-physiological severity of coronary artery disease can be obtained
with DET, based mainly on the temporal allocation of the transient
dyssynergy.
ARTICLES
Assessment of anatomic and physiological severity of single-vessel coronary artery lesions by dipyridamole echocardiography. Comparison with positron emission tomography and quantitative arteriography
CNR, Institute of Clinical Physiology, Pisa, Italy.
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