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European Heart Journal 1994 15(6):842-850;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Dipyridamole echocardiographic test performed 3 days after an acute myocardial infarction: feasibility, tolerability, safety and in-hospital prognostic value

F. CHIARELLA, S. DOMENICUCCI, P. BELLOTTI, P. BELLONE, G. SCARSI and C. VECCHIO

Cardiology Division, Ente Ospedaliero Ospedali Galliera Genoa, Italy

Received 23 September 1993; revised 15 February 1994; .

Correspondence. Dr Francesco Chiarella, Divisione di Cardiologia, Ente Ospedaliero Ospedale Galliera, Via Volta 8. 16128 Genoa, Italy.

Abstract

In recent years, increasing evidence has pointed to the potential of dipyridamole stress echocardiography as a fast, effective, inexpensive method of risk stratification after an acute myocardial infarction. A very early stratification by this test could improve the patient's management and reduce the duration of in-hospital stay, and, thus, the costs.

Two-hundred and fifty-one consecutive patients (208 male, age 58 ± 11) with a two-dimensional echocardiogram of good technical quality underwent a dipyridamole echocardiographic test (DET) 70 ±6 h after an acute myocardial infarction. Criterion for positivity was the identification of a transient regional asynergy that was absent or of a lower degree in the baseline examination. Positivity was defined as ‘at low-dose’ or ‘at high- dose’ if the asynergy was detected before or after the 8th min of a drug infusion. All tests were performed without any major side effects. DET was positive in 149 (59%) and negative in 102 (41%) patients. During the hospital stay, cardiac events (death, reinfarction, angina) occurred in 521251 patients: in 491149 with a positive and in 31102 with a negative test (sensitivity 94%, negative predictive value 97%, P<000001). Severe events (death and reinfarction) occurred in 14/251: in 121149 with a positive DET and in 21102 with a negative DET (sensitivity 86%; negative predictive value: 98%; V<0.05). Moreover, cardiac events occurred in 28165 patients with a low-dose positive DET, in 21184 with a high-dose positive DET and in 31102 with a negative DET (low-dose positive vs negative DET: P<0 00001, and vs high-dose positive DET: P<002; high-dose positive vs negative DET: P<000001). Hence, DET performed 3 days after acute myocardial infarction is feasible, well tolerated and safe, and allows early stratification of patients with different degrees of risk of in-hospital cardiac events.

Key Words: Dipyridamole echocardiography • postinfarction prognosis • acute myocardial infarction • pharmacological echo-stress test


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