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European Heart Journal 1988 9(11):1206-1214;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Efficacy of intravenous dipyridamole with exercise in thallium-201 myocardial perfusion scintigraphy

G.J. LAARMAN*,§, A.V.G. BRUSCHKE{dagger}, F.J. VERZULBERGEN{ddagger}, E.T. BAL*, E.E.VANDER WALL{dagger} and C.A.P.L. ASCOOP*,

*Department of Cardiology
{dagger}Department of Cardiology,University Hospital Leiden, The Netherlands
{ddagger}Department of Nuclear Cardiology, St Antonius Hospital Nieuwegein

Received 6 November 1987; revised 19 May 1988; .

Address for reprintDr c. A P. L. Ascoop, M D , Department of Cardiology. Si Antonius Hospital. P.O. Box 2500. 3430 EM.Nieuwegein. The Netherlands

Abstract

To assess the feasibility and the value of thallium–201 myocardial perfusion imaging with intravenous dipyridamole in combination with low-level exercise, 81 patients with suspected or proven coronary artery disease were studied. All patients underwent coronary arteriography. Significant coronary artery disease (stenoses ≥ 50%) was present in 59 patients (73%); multivessel disease (double- and triple-vessel desease) was observed in 33 patients (42%). The overall sensitivity and specificity of the test were 78% and 86%, respectively. Sensititvity and specificity for detection of multivessel disease were 70% and 92%, respectively. The sensitivity for detecting coronary artery disease in the RCA, LAD, and LCX was 74%, 82% and 48%, respectively, and the specificity was 85%, 88% and 88%, respectively. With the combined procedure no serious side effects were observed. Mild side effects like headche, vertigo and uausea were seen in 12 patients (15%).

Twenty volunteers with a ≤1% likelihood of significant coronary artery disease were examined in the same manner to determine the maximal specificity of the procedure (100%). Thus, the combination of two different stress procedures (exercise testing and dipyridamole infusion) can be performed safely without serious side effects. The presence, location and extent of significnt coronary artery disease can be assessed to a similar degree as with conventional exercise thallium-201 scintigraphy, which has major implications for the detection of coronary artery disease in patients who are unable to perform maximal exercise.

Key Words: Dipyridamole exercise thallium scintigraphy, • pharmacologic vasodilation, • stress testing.


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