Dipyridamole perfusion scintigraphy*

https://doi.org/10.1016/S0001-2998(05)80044-3Get rights and content

Dipyridamole is one of several agents that may be infused intravenously to noninvasively evaluate coronary perfusion without dynamic exercise. Among such agents it is the most investigated, and it is associated with the greatest clinical experience. Its mechanism of action utilizes intrinsic adenosine and does not require the induction of ischemia. Rather, the method tests the coronary flow reserve by dilating the precapillary and arteriolar capillary beds. Vessels with a limited coronary flow reserve demonstrate reduced responsiveness with relative flow reduction and a resultant defect on perfusion scintigraphy. Side effects are common and generally benign, but deaths have been reported and they generally relate to severe hypotension, prolonged dense ischemia and resultant infarction, or bronchospasm. Severe complications are rare and can be avoided by the prompt administration of aminophylline, the dipyridample antedote. Diagnostic accuracy for the identification of coronary disease appears similar to that for exercise perfusion scintigraphy. It should be applied to patients with known or suspected coronary disease who require coronary evaluation, but who cannot exercise adequately for diagnostic or prognostic purposes. In such patients, the method is useful for the preoperative assessment of risk at peripheral vascular and other major noncardiac surgery. It may be of value as well in the assessment of the otherwise uncomplicated patient postinfarction. Not yet established is its application to the patient with unstable angina or in the acute setting, after coronary reperfusion. Similarly, its comparison with direct adenosine infusion or with pharmacological agents whose mechanism rests entirely on ischemia induction, as does dobutamine, has until now been limited. Unlike its use with perfusion scintigraphy, the application of dipyridamole with echocardiography and other functional ischemic indicators is totally dependent on the induction of ischemia. This is likely less frequent than the induction of nonischemic perfusion heterogeneity. The agent is now commonly available and will make a significant beneficial impact on patient evaluation and management.

References (166)

  • IskandrianAS et al.

    Dipyridamole cardiac imaging

    Am Heart J

    (1988)
  • GranatoJE et al.

    Effects of dipyridamole and aminophylline on hemodynamics, regional myocardial blood flow and thallium-201 washout in the setting of a critical coronary stenosis

    J Am Coll Cardiol

    (1990)
  • MarchantE et al.

    Acute effect of systemic versus intracoronary dipyridamole on coronary circulation

    Am J Cardiol

    (1986)
  • SorensenSG et al.

    Regional myocardial blood flow in man during dipyridamole coronary vasodilation

    Chest

    (1985)
  • CasalePN et al.

    Simultaneous low level treadmill exercise and intravenous dipyridamole stress thallium imaging

    Am J Cardiol

    (1988)
  • Borges-NetoS et al.

    Quantitative thallium-201 single photon emission computed tomography after oral dipyridamole for assessing the presence, anatomic location and severity of coronary artery disease

    J Am Coll Cardiol

    (1988)
  • HommaS et al.

    Usefulness of oral dipyridamole suspension for stress thallium imaging without exercise in the detection of coronary artery disease

    J Am Coll Cardiol

    (1986)
  • JainA et al.

    Comparison of early exercise treadmill test and oral dipyridamole thallium-201 tomography for the identification of jeopardized myocardium in patients receiving thrombolytic therapy for acute Q-wave myocardial infarction

    Am J Cardiol

    (1990)
  • TailleferR et al.

    Thallium-201 myocardial imaging during pharmacologic coronary vasodilation: Comparison of oral and intravenous administration of dipyridamole

    J Am Coll Cardiol

    (1986)
  • ZhuYY et al.

    The clinical and pathophysiologic implications of pain, ST abnormalities and scintigraphic changes during dipyridamole infusion: Their relationship to the peripheral hemodynamic response

    Am Heart J

    (1988)
  • LaarmanGJ et al.

    Ischemic St segment changes after dipyridamole infusion

    Int J Cardiol

    (1987)
  • ChambersCE et al.

    Dipyridamole induced ST segment depression during thallium-201 imaging in patients with coronary artery disease: Angiographic and hemodynamic determinants

    J Am Coll Cardiol

    (1988)
  • LevinsonJR et al.

    Usefulness of semiquantitative analysis of dipyridamole-thallium redistribution for improving risk stratification before vascular surgery

    Am J Cardiol

    (1990)
  • OkadaRD et al.

    Significance of increased lung thallium-201 activity on serial cardiac images after dipyridamole treatment in coronary heart disease

    Am J Cardiol

    (1984)
  • ChouraquiP et al.

    Significance of dipyridamole induced transient dilation of the left ventricle during thallium-201 scintigraphy in sus

    Am J Cardiol

    (1990)
  • LetteJ et al.

    Transient left ventricular cavitary dilation during dipyridamole-thallium imaging as an indicator of severe coronary artery disease

    Am J Cardiol

    (1990)
  • BellerGA et al.

    Sensitivity, specificity, and prognostic significance of noninvasive testing for occult or known coronary disease

    Prog Cardiovasc Dis

    (1987)
  • JosephsonMA et al.

    Noninvasive detection and localization of coronary stenosis in patients: Comparison of resting, dipyridamole and exercise thallium-201 myocardial perfusion imaging

    Am Heart J

    (1982)
  • McAnultyJH et al.

    Improvement in left ventricular wall motion following nitroglycerine

    Circulation

    (1974)
  • HelfantRH et al.

    Nitroglycerine to unmask reversible asynergy

    Circulation

    (1974)
  • PopioKA et al.

    Postextrasystolic potentiation as a predictor of potential myocardial viability: Preoperative analysis compared with studies after coronary artery bypass graft surgery

    Am J Cardiol

    (1977)
  • CornishAL et al.

    Limitations of postextrasystolic potentiation in identifying ischemic myocardium

    Am J Physiol

    (1981)
  • MovahedA et al.

    Dobutamine and improvement of regional and global left ventricular function in coronary artery disease

    Am J Cardiol

    (1990)
  • SavasV et al.

    Dobutamine stress echocardiography: An alternative to thallium scintigraphy

    Circulation

    (1990)
  • BotvinickEH et al.

    Thallium-201 myocardial perfusion scintigraphy for the clinical clarification of normal, abnormal and equivocal exercise tests

    Am J Cardiol

    (1978)
  • OkadaRD et al.

    Myocardial kinetics of technetium-99m-hexakis-2-methoxy-2methyl propyl-isonitrile

    Circulation

    (1988)
  • WackersFJ et al.

    Technetium-99m-hexakis-2-methoxy isobutyl isonitrile: Human biodistribution, dosimetry, safety and preliminary comparison to thallium 201 for myocardial perfusion imaging

    J Nucl Med

    (1989)
  • GouldKL

    Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilation. I. Physiologic basis and experimental validation

    Am J Cardiol

    (1978)
  • MelinJA et al.

    Quantitative relationship between global left ventricular thallium uptake and blood flow: Effects of propranolol, ouabain, dipyridamole, and coronary artery occlusion

    J Nucl Med

    (1986)
  • StraussHW et al.

    Thallium-201 for myocardial imaging. Relationship of thallium-201 to regional myocardial perfusion

    Circulation

    (1975)
  • BotvinickEH et al.

    Analysis of thallium-201 “washout” from parametric color-coded images

    J Nucl Med

    (1988)
  • MaddahiJ et al.

    Improved noninvasive assessment of coronary artery disease: Quantitative analysis of regional stress myocardial distribution and washout of thallium-201

    Circulation

    (1981)
  • CannonRO et al.

    Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction

    Circulation

    (1987)
  • KlockeFJ

    Measurement of coronary flow reserve: Defining pathophysiology versus making decisions about patient care

    Circulation

    (1987)
  • GouldKL et al.

    Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilation. V. Detection of 47 percent diameter coronary stenosis with intravenous nitrogen-13 ammonia and emission computed tomography in intact dogs

    Am J Cardiol

    (1978)
  • DilsiziamV et al.

    Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging

    N Engl J Med

    (1990)
  • KaualS et al.

    Influence of peak exercise heart rate on normal thallium-201 myocardial clearance

    J Nucl Med

    (1986)
  • MassieB et al.

    Correlation of thallium-201 scintigrams with coronary anatomy: Factors affecting region by region sensitivity

    Am J Cardiol

    (1979)
  • HolmbergS et al.

    Coronary circulation during heavy exercise in control subjects and patients with coronary heart disease

    Acta Med Scand

    (1971)
  • GoldmanL et al.

    Multifactorial index of cardiac risk in noncardiac surgical procedures

    N Engl J Med

    (1977)
  • Cited by (27)

    • Enhanced detection of reversible perfusion defects by Tc-99m sestamibi compared to Tc-99m tetrofosmin during vasodilator stress SPECT imaging in mild-to-moderate coronary artery disease

      2001, Journal of the American College of Cardiology
      Citation Excerpt :

      Exclusion criteria included severe coronary disease (left main stem disease, >90% stenosis in any artery, three-vessel disease), previous myocardial infarction, significant valvular disease, left bundle branch block and clinically unstable CAD. Standard exclusion criteria for dipyridamole stress were applied (11). The protocol was approved by the Institutional Review Boards of both institutions.

    • Comparison of pharmacologic stress agents

      1996, Journal of Nuclear Cardiology
    • Pharmacologic stress myocardial perfusion imaging

      1993, Current Problems in Cardiology
    • Pharmacologic Stress Agents for Cardiac Imaging

      2013, Current Cardiovascular Imaging Reports
    • How should we stress the human heart?

      2013, From Basic Cardiac Imaging to Image Fusion: Core Competencies Versus Technological Progress
    View all citing articles on Scopus
    *

    Supported in part by a grant from the Fannie Rippel Foundation, Annandale, NJ.

    View full text