Functional significance of myocardial perfusion defects induced by dipyridamole using thallium-201 single-photon emission computed tomography and two-dimensional echocardiography

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      The mechanisms responsible for inhomogeneous myocardial blood flow after oral administration of a large dose (300 mg) of dipyridamole were assessed in 27 patients with serial thallium-201 single-photon emission computed tomography (SPECT) and simultaneous 2-dimensional echocardiograms. Myocardial tomographic images were obtained 50 minutes and 3 to 4 hours after administration of dipyridamole. Two-dimensional echocardiograms were recorded at baseline and then every 15 minutes for 60 minutes. Dipyridamole caused only a mild reduction in blood pressure (from 129 ± 18 to 126 ± 16 mm Hg) and a mild increase in heart rate (from 69 ± 15 to 73 ± 4 beats/min).
      Sixteen patients had perfusion defects after dipyridamole by SPECT, which underwent partial or total filling-in. Fourteen of these patients (87.5%) had either a new abnormality or further deterioration of a preexisting wall motion abnormality by 2-dimensional echocardiography, and thus were considered to have developed transient ischemia during dipyridamole administration. Ten of 11 patients (91%) with normal perfusion or fixed defects by SPECT had no further deterioration in wall motion after oral dipyridamole, and were thus considered to have no evidence of myocardial ischemia.
      In conclusion, most patients with transient thallium-201 defects after dipyridamole develop transient worsening of resting wall motion by 2-dimensional echocardiography, suggestive of true myocardial ischemia. Because myocardial oxygen demand, as indicated by the heart rate-blood pressure product, did not change significantly, the mechanism of myocardial ischemia in these patients is likely to be diminished regional blood flow related to a “subendocardial steal” induced by dipyridamole.
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        • Leppo J
        • Boucher CA
        • Okada RD
        • Newell JB
        • Strauss WH
        • Pohost GM
        Serial thallium-201 myocardial imaging after dipyridamole infusion: diagnostic utility in detecting coronary stenoses and relationship to regional wall motion.
        Circulation. 1982; 66: 639-657
        • Leppo JA
        • O'Brien J
        • Rothendler JA
        • Getchell JD
        • Lee VW
        Dipyridamole thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction.
        N Engl J Med. 1984; 310: 1014-1018
        • Homma S
        • Callahan RJ
        • Ameer B
        • McKusich KA
        • Strauss HW
        • Okada RD
        • Boucher CA
        Usefulness of oral dipyridamole suspension for stress thallium imaging without exercise in the detection of coronary artery disease.
        Am J Cardiol. 1986; 57: 503-508
        • Borges-Neto S
        • Mahmarian JJ
        • Jain A
        • Roberts R
        • Verani MS
        Quantitative thallium-201 single-photon computed tomography after oral dipyridamole for assessing the presence, anatomic location and severity of coronary artery disease.
        J Am Coll Cardiol. 1988; 11: 962-969
        • Francisco DA
        • Coffins SM
        • Go RT
        • Ehrhardt JC
        • Van Kirk OC
        • Marcus ML
        Tomographic thallium-201 myocardial perfusion scintigrams after maximal coronary vasodilation with intravenous dipyridamole: comparison of qualitative and quantitative approaches.
        Circulation. 1982; 66: 370-379
        • Boucher CA
        • Okada RD
        Thallium-201 myocardial imaging without exercise. Rest and dipyridamole studies.
        Chest. 1984; 86: 158-161
        • Reisman S
        Dipyridamole thallium testing: an alternative form of stress testing in patients unable to exercise (editorial).
        Chest. 1985; 88: 321-322
        • Albro PC
        • Gould KL
        • Westcott RJ
        • Hamilton GW
        • Ritchie JL
        • Williams DL
        Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilation. III. Clinical trial.
        Am J Cardiol. 1978; 42: 751-760
        • Gould KL
        Assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. IV. Limits of stenosis by idealized, experimental, cross-sectional myocardial imaging.
        Am J Cardiol. 1978; 42: 761-768
        • Kinsella D
        • Traup W
        • McGregor M
        Studies with a new coronary vasodilator drug: Persantine.
        Am Heart J. 1968; 63: 145-151
        • Knabb RM
        • Gidday JM
        • Ely SW
        • Rubio R
        • Berne RM
        Effects of dipyridamole on myocardial adenosine and active hyperemia.
        Am J Physiol. 1975; 247: H804-H810
        • Kobayashi A
        • Ogawa K
        Effects of coronary vasodilatory on cyclic nucleotides. The concentration of cyclic AMP and cyclic GMP in canine coronary artery and left ventricular muscle following the administration of various coronary vasodilators.
        Jpn Circ J. 1979; 43: 6-8
        • Pearlman JD
        • Boucher CA
        Diagnostic value for coronary artery disease of chest pain during dipyridamole-thallium stress testing.
        Am J Cardiol. 1988; 61: 43-45
        • Epstein SE
        • Cannon III, RO
        • Talbot TL
        Hemodynamic principles in the control of coronary blood flow.
        Am J Cardiol. 1985; 56: 4E-10E
        • Jain A
        • Mahmarian JJ
        • Borges-Neto S
        • Johnston DL
        • Cashion WR
        • Lewis JM
        • Raizner AE
        • Verani MS
        Clinical significance of perfusion defects by thallium-201 single photon emission tomography following oral dipyridamole early after coronary angioplasty.
        J Am Coll Cardiol. 1988; 11: 970-976
        • VanReet RE
        • Quinones MA
        • Poliner LR
        • Nelson JG
        • Waggoner AD
        • Kanon D
        • Lubetkin SJ
        • Pratt CM
        • Winters Jr, WL
        Comparison of 2-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction.
        J Am Coll Cardiol. 1984; 3: 243-252
        • Gross GJ
        • Wartier DC
        Coronary steal in 4 models of single or multiple vessel obstruction in dogs.
        Am J Cardiol. 1981; 48: 84-92
        • Becker LC
        Conditions for vasodilator-induced coronary steal in experimental myocardial ischemia.
        Circulation. 1978; 57: 1103-1110
        • Beller GA
        • Holzgrefe HH
        • Watson DD
        Effects of dipyridamole-induced vasodilation on myocardial uptake and clearance kinetics of thallium-201.
        Circulation. 1983; 68: 1328-1338
        • Picano E
        • Distante A
        • Masini M
        • Morales MA
        • Lattanzi F
        • L'abbate A
        Dipyridamole-echocardiography test in effort angina pectoris.
        Am J Cardiol. 1985; 56: 452-456
        • Picano E
        • Masini M
        • Distante A
        • Simonetti I
        • Lattanzi F
        • Marzilli M
        • L'abbate A
        Dipyridamole-echocardiography test in patients with exercise-induced ST-segment elevation.
        Am J Cardiol. 1986; 57: 765-768
        • Labovitz AJ
        • Pearson AC
        • Chaitman BR
        Doppler and 2-dimensional echocardiographic assessment of left ventricular function before and after intravenous dipyridamole stress testing for detection of coronary artery disease.
        Am J Cardiol. 1988; 62: 1180-1185