Document Detail


Simultaneous dipyridamole/maximal subjective exercise with 99mTc-MIBI SPECT: improved diagnostic yield in coronary artery disease.
MedLine Citation:
PMID:  9060889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We attempted to demonstrate that simultaneous dipyridamole administration and maximal subjective exercise in patients who are unable to achieve a good exercise level can improve the diagnostic efficacy of technetium-99m methoxy isobutyl isonitrile (99mTc-MIBI) myocardial single-photon emission computed tomography (SPECT). BACKGROUND: The results of myocardial perfusion scintigraphy are unsatisfactory if the level of exercise achieved by the patient is insufficient. The use of dipyridamole with maximal subjective stress testing has been shown to improve the quality of the thallium-201 myocardial perfusion images, but there are no studies demonstrating that this combination improves the diagnostic accuracy of myocardial perfusion SPECT. METHODS: Two hundred thirty-one consecutive patients, without a previous myocardial infarction, were classified into three groups: group 1, 91 patients with an adequate exercise test; group 2, 68 patients with an inadequate exercise test; group 3, 72 patients with an inadequate exercise test who then received intravenous dipyridamole (0.56 mg/kg body weight over 4 min) simultaneously with exercise. RESULTS: Results for sensitivity (89%) and negative predictive value (83%) in group 3 were significantly better than those in group 2 (71% [p = 0.03] and 56% [p = 0.002], respectively) and not significantly different from those in group 1. The polar maps of 20 patients studied with an without dipyridamole at the same exercise level revealed a significantly greater extent of ischemia in each territory and in a global assessment (19 + 20% vs. 8 + 11%, p < 0.0001) when dipyridamole was administered during physical exercise. CONCLUSIONS: Intravenous dipyridamole administration during exercise testing is advisable in all patients who are unable to achieve an adequate exercise level. This approach permits physicians to avoid missing ergometric information while optimizing myocardial SPECT results.
Authors:
J Candell-Riera; C Santana-Boado; J Castell-Conesa; S Aguadé-Bruix; M Olona; J Palet; J Cortadellas; A García-Burillo; J Soler-Soler
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  29     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-04-04     Completed Date:  1997-04-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  531-6     Citation Subset:  AIM; IM    
Affiliation:
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. jcandell@ar.vhebron.es
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MeSH Terms
Descriptor/Qualifier:
Coronary Disease / radionuclide imaging*
Dipyridamole / diagnostic use*
Exercise Test
Female
Heart Catheterization
Humans
Male
Middle Aged
Prospective Studies
Radiopharmaceuticals / diagnostic use*
Sensitivity and Specificity
Technetium Tc 99m Sestamibi / diagnostic use*
Vasodilator Agents / diagnostic use*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Vasodilator Agents; 109581-73-9/Technetium Tc 99m Sestamibi; 58-32-2/Dipyridamole

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


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