Circulation, Vol 76, 943-951, Copyright © 1987 by American Heart Association
AY Fung, KP Gallagher and AJ Buda
Noninvasive cardiac imaging with echocardiography or thallium-201
scintigraphy utilizing pharmacologic agents as alternatives to exercise is
gaining popularity. We investigated the physiologic rationale underlying
the optimal choice of pharmacologic stress for functional versus perfusion
imaging. With the use of an open-chest dog model, a critical stenosis of
the left circumflex coronary artery was produced with total ablation of
hyperemic response to a 15 sec period of complete occlusion. Regional left
ventricular wall thickening was assessed by quantitative two-dimensional
echocardiography. Regional myocardial blood flow was determined by
microspheres in both the flow- restricted left circumflex area and the
control area supplied by the left anterior descending artery. Eight dogs
received 15 micrograms/kg/min dobutamine intravenously for 10 min, and nine
dogs received 0.14 mg/kg/min dipyridamole intravenously for 4 min.
Dobutamine induced wall thickening abnormalities in all dogs while
dipyridamole induced dysfunction in only 55% of the animals studied (p less
than .01). Subendocardial blood flow to the left circumflex area was
unchanged after both dobutamine and dipyridamole when compared with
baseline blood flow. However, subendocardial blood flow increased markedly
after dipyridamole in the control area. Regional subendocardial blood flow
ratio (left anterior descending/left circumflex) was 3.74 +/- 0.09 (mean
+/- SEM) after dipyridamole versus 1.27 +/- 0.09 after dobutamine (p less
than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The physiologic basis of dobutamine as compared with dipyridamole stress interventions in the assessment of critical coronary stenosis
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
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