Assessment of anatomic and physiological severity of single-vessel coronary artery lesions by dipyridamole echocardiography. Comparison with positron emission tomography and quantitative arteriography.

Ovid Technologies (Wolters Kluwer Health) - Tập 89 Số 2 - Trang 753-761 - 1994
E. Picano1, Oberdan Parodi2, Fabio Lattanzi3, Gianmario Sambuceti4, Maria João Andrade5, Paolo Marzullo6, Assuero Giorgetti7, Piero Salvadori8, Mario Marzilli9, A. Distante10
1E Picano CNR, Institute of Clinical Physiology, Pisa, Italy.
2O Parodi CNR, Institute of Clinical Physiology, Pisa, Italy.
3F Lattanzi CNR, Institute of Clinical Physiology, Pisa, Italy.
4G Sambuceti CNR, Institute of Clinical Physiology, Pisa, Italy.
5M J Andrade CNR, Institute of Clinical Physiology, Pisa, Italy.
6P Marzullo CNR, Institute of Clinical Physiology, Pisa, Italy.
7A Giorgetti CNR, Institute of Clinical Physiology, Pisa, Italy.
8P Salvadori CNR, Institute of Clinical Physiology, Pisa, Italy.
9M Marzilli CNR, Institute of Clinical Physiology, Pisa, Italy.
10A Distante CNR, Institute of Clinical Physiology, Pisa, Italy.

Tóm tắt

BACKGROUND The aim of this study was to compare the results of dipyridamole-echocardiography test (DET: two-dimensional echo monitoring during dipyridamole infusion up to 0.84 mg/kg over a period of 10 minutes) with both anatomic and physiological parameters of coronary artery disease severity, assessed by computer-assisted quantitative coronary arteriography, and regional coronary flow reserve, measured by [13N]ammonia (13NH3) and dynamic positron emission tomography (PET), respectively. METHODS AND RESULTS We studied 31 patients with a history of chest pain and neither previous myocardial infarction nor resting wall motion abnormalities. Eighteen patients had single-vessel disease (> 50% stenosis of one major coronary vessel), and 13 had normal coronary arteries. The criterion for DET positivity was the appearance of a new transient regional wall motion abnormality. In patients with a positive DET, two parameters were evaluated: the dipyridamole time (ie, the time from the beginning of drug infusion to the development of obvious dyssynergy) and the wall motion score index (WMSI, a semiquantitative integrated estimation of extent and severity of the stress-induced dyssynergy). WMSI was derived by summation of individual segment scores divided by the number of segments interpreted. Quantification of regional myocardial blood flow was obtained by PET measurements of 13NH3 arterial input function and left ventricular myocardial tissue concentration both at control and after dipyridamole (0.56 mg/kg over 4 minutes). Maximal regional blood flow after dipyridamole in the region supplied by the stenotic vessel was significantly lower in the 11 patients with coronary artery disease and positive DET than in the 7 patients with coronary artery disease and negative DET (1.08 +/- 0.33 versus 1.98 +/- 0.37 mL.min-1.g-1, P < .01). In patients with a positive DET, regional coronary flow reserve correlated well with dipyridamole time (r = .87, P < .01) but not with peak WMSI (r = .25, P = NS). Patients with dipyridamole-induced akinesia or dyskinesia (n = 6) had a greater reduction in regional coronary flow reserve than did those showing hypokinesia (n = 5): 1.38 +/- 0.51 versus 2.17 +/- 0.42, P < .05. Percent area reduction was more severe in patients with DET positivity than in those with DET negativity (93.7 +/- 8.7% versus 77 +/- 10.3%, P < .01), and it correlated with regional coronary flow reserve (r = .64, P < .01) and dipyridamole time (r = -.59, P < .01). CONCLUSIONS In patients with single-vessel disease, DET shows an excellent specificity but a limited sensitivity; in these patients, DET positivity is associated with a physiologically important coronary stenosis. Severity of the anatomic stenosis and impairment in regional flow reserve are greater when the dipyridamole-induced dyssynergy appears earlier during the test. Therefore, a stratification of the anatomo-physiological severity of coronary artery disease can be obtained with DET, based mainly on the temporal allocation of the transient dyssynergy.

Từ khóa


Tài liệu tham khảo

Thông tin
Thông tin xuất bản

Ovid Technologies (Wolters Kluwer Health)

Tập 89 Số 2

753-761

Thông tin tác giả