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Low-dose dipyridamole infusion acutely increases exercise capacity in angina pectoris - A double-blind, placebo controlled crossover stress echocardiographic study

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第1期35卷 83-88页

作者： Tommasi, S Carluccio, E Bentivoglio, M Corea, L Picano, E CNR Inst Clin Physiol I-56100 Pisa Italy Univ Perugia Dept Clin & Expt Med Cardiol Unit Perugia Italy

OBJECTIVES The aim of this study was to assess whether endogenous accumulation of adenosine, induced by low-dose dipyridamole infusion, protects from exercise-induced ischemia. BACKGROUND Adenosine is a recognized mediator of ischemic preconditioning in experimental settings. METHODS Ten patients (all men: mean age 63.4 +/- 7.3 years) with chronic stable angina, angiographically assessed coronary artery disease (n = 7) or previous myocardial infarction (n = 3) and exercise-induced ischemia underwent on different days two exercise-stress echo tests after premedication with placebo or dipyridamole (15 mg in 30 min, stopped 5 min before testing) in a double-blind, placebo controlled, randomized crossover design. RESULTS In comparison with placebo, dipyridamole less frequently induced chest pain (20% vs. 100%, p = 0.001) and >0.1 mV ST segment depression (50% vs. 100%, p < 0.05). Wall motion abnormalities during exercise-stress test were less frequent (placebo = 100% vs. dipyridamole = 70%, p = ns) and significantly less severe (wall motion score index at peak stress: placebo = 1.55 +/- 0.17 vs, dipyridamole = 1.27 +/- 0.2, p < 0.01) following dipyridamole, which also determined an increase in exercise time up to echocardiographic positivity (placebo = 385.9 +/- 51.4 vs. dipyridamole = 594.4 +/- 156.9 s, p < 0.01). CONCLUSIONS Low-dose dipyridamole infusion increases exercise tolerance in chronic stable angina, possibly by endogenous adenosine accumulation acting on high affinity Al myocardial receptors involved in preconditioning or positively modulating coronary flow through collaterals. (C) 1999 by the American College of Cardiology.

关键词：腺苷/代谢心绞痛/药物疗法心绞痛/病理生理学交叉研究双嘧达莫/投药和剂量双嘧达莫/副作用剂量效应关系药物双盲法运动试验/药物作用术前用药法受体嘌呤能P1/药物作用受体嘌呤能P1/生理学血管舒张药/投药和剂量血管舒张药/副作用老年人女(雌)性人类男(雄)性中年人

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Lupus carditis:: Evaluation with technetium-99m MIBI myocardial SPECT and heart rate variability

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ANGIOLOGY 1999年第2期50卷 143-148页

作者： Laganà, B Schillaci, O Tubani, L Gentile, R Danieli, R Coviello, R Baratta, L Scopinaro, F Univ Roma La Sapienza Dept Clin Med I-00185 Rome Italy Univ Roma La Sapienza Sez Med Nucl Dept Med Sperimentale & Patol Rome Italy

The objective of this paper was to investigate the incidence of myocardial perfusion defects in patients with systemic lupus erythematosus (SLE) associated with dysautonomic alterations. Twenty patients without any sign or symptoms of heart disease, selected from a larger population of patients with SLE, underwent technetium-99m sestamibi (Tc-99m MIBI) single photon emission computed tomography (SPECT), at rest and after dipyridamole infusion;they also underwent heart rate variability (HRV) examination by a 24 hour ambulatory electrocardiography, analyzing in the time domain the standard deviation of the R-R intervals average (SDNN) and the percentage of R-R adjacent intervals differing from each other more than 50 msec (pNN50);in the frequency domain the low (LF) and high frequencies (HF) were analyzed. Twenty healthy volunteers served as control group for heart rate variability. At MIBI-SPECT examination, the scan was found abnormal in 15 patients and normal in five: three patients demonstrated reversible defects in the anteroseptal region, four had irreversible defects in a region (two in the anteroseptal region and two in the lateral region), two had rest defects in two different regions (lateral and inferior, lateral and anteroseptal) that improved during dipyridamole scan, and six had both reversible and irreversible defects: four in a single segment (three anteroseptal and one lateral, and two in two different regions, particularly anteroseptal and lateral, lateral and inferior). All 20 patients showed significantly lower HRV parameters in comparison with the control group, except for pNN50, which indicates decreased physiologic periodic fluctuations of the autonomic nervous system. In six patients who underwent coronary angiography, the epicardial vessels were found completely normal. In view of the high incidence of myocardial hypoperfusion in patients with HRV alterations, the authors hypothesize that autonomic dysfunction may be associated with microvascu

关键词：自主神经系统疾病/病理生理学病例对照研究冠状血管造影术冠状动脉循环/生理学冠状血管/病理生理学双嘧达莫/投药和剂量双嘧达莫/诊断应用心电描记术便携式心脏传导系统/病理生理学心率/生理学心间隔/病理生理学发病率红斑狼疮系统性/病理生理学红斑狼疮系统性/放射性核素显像心肌收缩/生理学心肌炎/病理生理学心肌炎/放射性核素显像心包/病理学放射性药物/诊断应用不应期电生理学/生理学信号处理计算机辅助 99m锝甲氧基异丁基异腈/诊断应用体层摄影术发射型计算机单光子血管舒张药/投药和剂量血管舒张药/诊断应用青少年成年人女(雌)性人类男(雄)性中年人

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Integrated evaluation of relation between coronary lesion features and stress echocardiography results: The importance of coronary lesion morphology

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期33卷 717-726页

作者： Beleslin, BD Ostojic, M Djordjevic-Dikic, A Babic, R Nedeljkovic, M Stankovic, G Stojkovic, S Marinkovic, J Nedeljkovic, I Stepanovic, J Saponjski, J Petrasinovic, Z Nedeljkovic, S Kanjuh, V Univ Belgrade Ctr Clin Serbia Dept Diagnost & Catheterizat Labs Inst Cardiovasc Dis YU-11000 Belgrade Yugoslavia

OBJECTIVES The aim of this study was to analyze, in the same group of patients, the relationship between multiple variables of coronary lesion and results of exercise, dobutamine and dipyridamole stress echocardiography tests. BACKGROUND Integrated evaluation of the relation between stress echocardiography results and angiographic variables should include not only the assessment of stenosis severity but also evaluation of other quantitative and qualitative features of coronary stenosis. METHODS Study population consisted of 168 (138 male, 30 female, mean age 51 +/- 9 years) patients, on whom exercise (Bruce treadmill protocol), dobutamine (up to 40 mcg/kg/min) and dipyridamole (0.84 mg/kg over 10 min) stress echocardiography tests were performed. Stress echocardiography test was considered positive for myocardial ischemia when a new wall motion abnormality was observed. One-vessel coronary stenosis ranging from mild stenosis to complete obstruction of the vessel was present in 153 patients, and 15 patients had normal coronary arteries. The observed angiographic variables included particular coronary vessel, stenosis location, the presence of collaterals, plaque morphology according to Ambrose classification, percent diameter stenosis and obstruction diameter as assessed by quantitative coronary arteriography. RESULTS Covariates significantly associated with the results of physical and pharmacological stress tests included for all three stress modalities presence of collateral circulation, percent diameter stenosis and obstruction diameter, as well as lesion morphology (p < 0.05 for all, except collaterals for dobutamine stress test, p = 0.06). By stepwise multiple logistic regression analysis, the strongest predictor of the outcome of exercise echocardiography test was only percent diameter stenosis (p = 0.0002). However, both dobutamine and particularly dipyridamole stress echocardiography results were associated not only with stenosis severity-percent diameter ste

关键词：强心药/投药和剂量冠状血管造影术冠心病/诊断显像冠心病/病理生理学双嘧达莫/投药和剂量多巴酚丁胺/投药和剂量超声心动描记术/方法运动试验可行性研究随访研究心率输注静脉内心肌收缩敏感性与特异性疾病严重程度指数血管舒张药/投药和剂量成年人老年人女(雌)性人类男(雄)性中年人

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Adjunctive intracoronary dipyridamole in the interventional treatment of small coronary arteries: A prospectively randomized trial

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AMERICAN HEART JOURNAL 2000年第6期139卷 1039-1045页

作者： Heidland, UE Heintzen, MP Michel, CJ Strauer, BE Univ Dusseldorf Dept Cardiol Pneumol & Angiol Sch Internal Med D-40225 Dusseldorf Germany

Background Patients undergoing intracoronary stent placement or balloon angioplasty for the treatment of small coronary arteries are at an increased risk of an adverse outcome from a higher incidence of abrupt closure and restenosis. Intracoronary thrombus formation plays a key role in the pathogenesis of abrupt vessel closure and of restenosis. Dipyridamole prevents platelet aggregation by a mechanism that differs from aspirin. The purpose of this study was to investigate the effect of intracoronary dipyridamole on acute complications and restenosis after percutaneous transluminal coronary angioplasty. Methods In a prospectively randomized study including 491 dilatations of coronary arteries with a diameter <2.75 mm, additional intracoronary application of dipyridamole was compared with conventional pretreatment consisting of heparin and aspirin. Study end points were defined as incidence of abrupt vessel closure, myocardial infarction, angiographic restenosis, and target vessel revascularization rate. Results Intracoronary dipyridamole was associated with a significant reduction of abrupt vessel closure (2.8% vs 8.6%;P = .005) and a nonsignificant reduction of myocardial infarction (1.6% vs 4.5%;P = .07) after percutaneous transluminal coronary angioplasty. Net gain 6 months after angioplasty was significantly higher in the dipyridamole group (0.60 +/- 0.35 mm vs 0.42 +/- 0.34 mm;P <.001). However, dipyridamole foiled to reduce the incidence of angiographic restenosis (41.6% vs 49.1%;P = .11) and target vessel revascularization rare (20.6% vs 269%;P =.12). Conclusions Intracoronary dipyridamole reduces the incidence of adverse cardiovascular events in the first 48 hours after balloon angioplasty of small coronary arteries, Reduction of restenosis rates failed to reach statistical significance. However, a significant increase in net gain was observed. Thus intracoronary application of dipyridamole should be considered in the treatment of small coronary arteries whe

关键词：冠状血管双嘧达莫/投药和剂量发病率注射动脉内心肌梗死/放射摄影术心肌梗死/治疗血小板聚集抑制剂/投药和剂量前瞻性研究复发/预防和控制支架治疗结果女(雌)性人类男(雄)性中年人

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Prediction of human transplantation arteriopathy and coronary events with lung heart count ratios during intravenous dipyridamole thallium-201 imaging

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AMERICAN HEART JOURNAL 1999年第5期137卷 942-948页

作者： Lenihan, DJ Rosenbaum, AF Burwinkel, P Tseng, CY Bhat, G Wagoner, L Walsh, RA Gerson, MC Univ Cincinnati Div Cardiol Dept Internal Med Cincinnati OH 45267 USA Univ Cincinnati Div Epidemiol & Biostat Dept Environm Hlth Cincinnati OH 45267 USA Univ Cincinnati Eugene L Saenger Radioisotope Lab Dept Radiol Cincinnati OH 45267 USA

Background Cardiac allograft arteriopathy often limits long-term survival in transplantation recipients but has been difficult to-detect by standard diagnostic methods. Because of the diffuse nature of transplantation coronary disease, we postulated that a lung/heart ratio during dipyridamole thallium imaging might better predict arteriopathy-related complications than diagnostic methods that detect discrete luminal stenoses. Methods and Results Sixty-six unselected heart transplantation recipients were evaluated with annual coronary arteriograms, endomyocardial biopsy, and intravenous dipyridamole thallium testing (initial study group). The mean lung/heart ratio on an anterior planar image was 0.40 for all patients;therefore <0.40 was arbitrarily defined as normal. After October 1992, 98 patients were tested (validation study group) and a lung/heart ratio cutoff of 0.40 was evaluated prospectively. Coronary end points were defined as (1) at least 1 coronary artery stenosis greater than or equal to 50% of the luminal diameter, (2) sudden cardiac death, and (3) acute myocardial infarction. Stepwise:logistic regression analysis was performed to identify independent predictors of future coronary end points. For the initial study group, the lung/heart ratio on the first annual thallium study was the only independent predictor of subsequent cardiac end points (0.47 +/- 0.13 [SD] with end points vs 0.38 +/- 0.11 without end points, P<.05). For the validation study group, independent predictors of subsequent coronary events included the lung/heart ratio and the radionuclide left ventricular election fraction. No patient with a lung/heart ratio <0.40 and a left ventricular ejection fraction greater than or equal to 0.50 developed a cardiac event during 21 +/- 11 months of follow-up. Conclusions A lung/heart ratio greater than or equal to 0.40 on dipyridamole thallium testing is a sensitive predictor of coronary events after heart transplantation. Patients with heart transpl

关键词：冠心病/病因学冠心病/病理生理学冠心病/放射性核素显像冠状血管/放射性核素显像双嘧达莫/投药和剂量双嘧达莫/诊断应用随访研究注射静脉内肺/放射性核素显像试验预期值前瞻性研究可重复性结果每搏输出量铊放射性同位素/投药和剂量铊放射性同位素/诊断应用女(雌)性人类男(雄)性中年人

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Single-photon emission computed tomographic myocardial perfusion imaging in patients with mitral valve prolapse

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期85卷 516-518页

作者： Özkan, M Kaymaz, C Dinçkal, H Kirma, C Özdemir, N Akdemir, I Sönmez, K Mutlu, B Sansoy, V Önsel, Ç Kosuyolu Heart & Res Hosp Cardiol Clin TR-81020 Istanbul Turkey Istanbul Univ Cerrahpasa Med Fac Istanbul Turkey

Several studies have been undertaken using myocardial perfusion imaging to detect myocardial ischemia in patients with mitral valve prolapse (MVP).1–9 Controversial results were obtained in patients with MVP without coronary artery disease.1–11 Moreover, these previous studies have been performed mostly in the 1970s using planar myocardial perfusion imaging with thallium-201 (Tl-201).1–8 Recently, it was shown that single-photon emission computed tomography has better ability to allow visual analysis of all coronary regions in the diagnosis of coronary artery disease than planar imaging.12–14 This study was designed to assess myocardial perfusion imaging using single-photon emission computed tomographic (SPECT) analysis and recently established echocardiographic criteria for MVP.

关键词：胸痛/诊断胸痛/病因学诊断鉴别双嘧达莫/投药和剂量双嘧达莫/诊断应用超声心动描记术心电描记术运动试验注射静脉内二尖瓣脱垂/放射性核素显像二尖瓣脱垂/超声检查心肌缺血/诊断前瞻性研究放射性药物/投药和剂量放射性药物/诊断应用可重复性结果 99m锝甲氧基异丁基异腈/投药和剂量 99m锝甲氧基异丁基异腈/诊断应用体层摄影术发射型计算机单光子血管舒张药/投药和剂量血管舒张药/诊断应用成年人女(雌)性人类男(雄)性中年人

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Dipyridamole administration at the end of an insufficient exercise Tc-99m MIBI SPECT improves detection of multivessel coronary artery disease in patients with previous myocardial infarction

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第5期85卷 532-535页

作者： Candell-Riera, J Santana-Boado, C Castell-Conesa, J Aguadé-Bruix, S Bermejo-Fraile, B Soler-Soler, J Hosp Gen Univ Vall dHebron Serv Cardiol Barcelona 08035 Spain Hosp Gen Univ Vall dHebron Nucl Med Serv Barcelona 08035 Spain Hosp Gen Univ Vall dHebron Serv Med Preventiva Barcelona 08035 Spain

To demonstrate that the administration of dipyridamole at the end of an insufficient maximal subjective exercise test can improve the diagnostic accuracy of single-photon emission computed tomography in patients with previous myocardial infarction, 209 consecutive patients were studied with technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography and coronary angiography, Patients were divided in 3 groups: group 1, 107 patients with sufficient exercise testing;group 2, 55 patients with insufficient exercise testing;group 3, 47 patients with insufficient exercise testing in whom intravenous dipyridamole (0.56 mg/kg aver 4 minutes) was administered at the end of exercise. In groups 1 and 3 the sensitivity values for the diagnosis of multivessel disease were significantly higher (80% and 76%, respectively) than those in group 2 (59% [p = 0.009 and p = 0.02, respectively]). Specificity and predictive values were not different among the 3 groups. Thus, in patients with previous infarction in whom adequate levels of exercise could not be achieved, dipyridamole administration at the end of exercise significantly increased the sensitivity for diagnosing multivessel disease. (C)2000 by Excerpta Medica, Inc.

关键词：病例对照研究冠心病/并发症冠心病/流行病学冠心病/放射性核素显像双嘧达莫/投药和剂量双嘧达莫/诊断应用运动试验心脏导管插入术心肌梗死/并发症试验预期值前瞻性研究放射性药物/诊断应用敏感性与特异性 99m锝甲氧基异丁基异腈/诊断应用体层摄影术发射型计算机单光子血管舒张药/投药和剂量血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Dipyridamole stress echocardiography

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Cardiology Clinics 1999年第3期17.0卷 481-499页

作者： Picano, E. Sicari, R. Varga, A. Institute of Clinical Physiology 56100 Pisa Via Savi 8 Italy

Dipyridamole stress is the forerunner and prototype of pharmacological stress echo tests in the diagnosis of coronary artery disease. The safety of this test has been conclusively demonstrated as a result of extensive experience in large-scale multicenter projects. The diagnostic accuracy of dipyridamole stress echo is comparable to dobutamine and largely a function of the employed dose. Higher dosages (up to 0.84 mg/kg) are being required to achieve good sensitivity. The prognostic value has been shown to be independent and additive to clinical, exercise echocardiogram, and angiographic data. The test positive response should be titrated on the basis of severity, extent, and timing of induced dyssynergy with low positivity being associated to more anatomically and functionally severe forms of disease. Multicenter, randomized, prospective, international studies on cost- effectiveness directly comparing a noninvasive strategy centered on stress echo versus an invasive strategy centered on coronary angiography are currently ongoing.

关键词：肾上腺素能β激动剂/诊断应用强心药/诊断应用临床方案冠心病/代谢冠心病/超声检查双嘧达莫/投药和剂量双嘧达莫/诊断应用多巴酚丁胺/诊断应用超声心动描记术/方法心电描记术运动试验预后敏感性与特异性血管舒张药/投药和剂量血管舒张药/诊断应用人类

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