| 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. | |
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MedLine Citation:
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PMID: 18022108 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Edoardo Verna; Luca Ceriani; Stefano Provasoli; Simone Scotti; Sergio Ghiringhelli |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 2007-11-20 Completed Date: 2008-01-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9423534 Medline TA: J Nucl Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 818-26 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. edoardo.verna@virgilio.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Coronary Artery Disease
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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:
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0/Vasodilator Agents; 58-32-2/Dipyridamole |
| Comments/Corrections | |
Comment In:
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J Nucl Cardiol. 2007 Nov-Dec;14(6):769-74
[PMID:
18022102
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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