Document Detail


Dipyridamole perfusion scintigraphy.
MedLine Citation:
PMID:  1948114     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Dipyridamole is one of several agents that may be infused intravenously to nonivasively evaluate coronary perfusion without dynamic exercise. Among such agents it is the most investigated, and it is associated with the greatest clinical experience. Its mechanism of action utilizes intrinsic adenosine and does not require the induction of ischemia. Rather, the method tests the coronary flow reserve by dilating the precapillary and arteriolar capillary beds. Vessels with a limited coronary flow reserve demonstrate reduced responsiveness with relative flow reduction and a resultant defect on perfusion scintigraphy. Side effects are common and generally benign, but deaths have been reported and they generally relate to severe hypotension, prolonged dense ischemia and resultant infarction, or bronchospasm. Severe complications are rare and can be avoided by the prompt administration of aminophylline, the dipyridample antedote. Diagnostic accuracy for the identification of coronary disease appears similar to that for exercise perfusion scintigraphy. It should be applied to patients with known or suspected coronary disease who require coronary evaluation, but who cannot exercise adequately for diagnostic or prognostic purposes. In such patients, the method is useful for the preoperative assessment of risk at peripheral vascular and other major noncardiac surgery. It may be of value as well in the assessment of the otherwise uncomplicated patient postinfarction. Not yet established is its application to the patient with unstable angina or in the acute setting, after coronary reperfusion. Similarly, its comparison with direct adenosine infusion or with pharmacological agents whose mechanism rests entirely on ischemia induction, as does dobutamine, has until now been limited. Unlike its use with perfusion scintigraphy, the application of dipyridamole with echocardiography and other functional ischemic indicators is totally dependent on the induction of ischemia. This is likely less frequent than the induction of nonischemic perfusion heterogeneity. The agent is now commonly available and will make a significant beneficial impact on patient evaluation and management.
Authors:
E H Botvinick; M W Dae
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Seminars in nuclear medicine     Volume:  21     ISSN:  0001-2998     ISO Abbreviation:  Semin Nucl Med     Publication Date:  1991 Jul 
Date Detail:
Created Date:  1991-11-27     Completed Date:  1991-11-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1264464     Medline TA:  Semin Nucl Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  242-65     Citation Subset:  IM    
Affiliation:
Department of Medicine (Cardiology), University of California San Francisco 94143.
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MeSH Terms
Descriptor/Qualifier:
Coronary Disease / radionuclide imaging*
Dipyridamole / adverse effects,  diagnostic use*
Exercise Test
Heart / radionuclide imaging*
Humans
Thallium Radioisotopes / diagnostic use*
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes; 58-32-2/Dipyridamole
Comments/Corrections
Comment In:
Semin Nucl Med. 1991 Jul;21(3):170-2   [PMID:  1835135 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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