Document Detail


Larger perfusion defects with exercise compared with dipyridamole SPECT (exercise-dipyridamole mismatch) may reflect differences in epicardial and microvascular coronary dysfunction: when the stressor matters.
MedLine Citation:
PMID:  18022108     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Previous studies have reported larger myocardial perfusion defects with exercise as compared with dipyridamole. The aim of this study was to assess the hypothesis that this mismatch may reflect differences in epicardial and microvascular coronary vasomotor function. METHODS AND RESULTS: The response to intracoronary acetylcholine, nitroglycerin, and adenosine was studied in 36 patients with suspected angina and normal or near-normal coronary angiography findings who underwent both exercise and dipyridamole perfusion imaging. Of the patients, 27 (75%) had reversible defects with exercise (group I) and 9 had normal scans or nonreversible defects (group II). Repeated imaging with dipyridamole showed significant improvement or disappearance of perfusion defects in group I patients. The mean summed difference score (SDS) decreased from 5.52 +/- 3.19 with exercise to 1.11 +/- 1.60 with dipyridamole (P = .0001) in group I and did not change in group II. An abnormal epicardial response to acetylcholine, reflecting endothelial dysfunction, occurred in 93% of group I patients compared with only 33% of group II patients (chi(2) = 9.46, P = .002) and was significantly related to exercise SDS (r = 0.49, P = .002) but not to dipyridamole SDS. By contrast, most patients showed normal epicardial and microvascular responses to the mainly non-endothelium-dependent vasodilators nitroglycerin and adenosine with no differences in coronary flow reserve between groups (2.91 +/- 0.72 vs 2.98 +/- 0.52, P = .79). CONCLUSIONS: Exercise-dipyridamole perfusion mismatch may reflect differences in epicardial endothelial and microvascular dysfunction.
Authors:
Edoardo Verna; Luca Ceriani; Stefano Provasoli; Simone Scotti; Sergio Ghiringhelli
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  14     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2007 Nov-Dec
Date Detail:
Created Date:  2007-11-20     Completed Date:  2008-01-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  818-26     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. edoardo.verna@virgilio.it
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Disease / radionuclide imaging*
Dipyridamole / diagnostic use*
Exercise Test / methods*
Female
Humans
Male
Microcirculation / radionuclide imaging
Middle Aged
Pericardium / radionuclide imaging*
Reproducibility of Results
Sensitivity and Specificity
Tomography, Emission-Computed, Single-Photon / methods*
Vasodilator Agents / diagnostic use
Vasomotor System / radionuclide imaging*
Ventricular Dysfunction, Left / radionuclide imaging*
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 58-32-2/Dipyridamole
Comments/Corrections
Comment In:
J Nucl Cardiol. 2007 Nov-Dec;14(6):769-74   [PMID:  18022102 ]

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


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