European Heart Journal Advance Access originally published online on December 16, 2005
European Heart Journal 2006 27(4):499; doi:10.1093/eurheartj/ehi689
Dipyridamole echocardiography test in patients with normal or near normal coronary arteries
Department of Cardiology
Hospital Universitario Gregorio Marañón
Dr Esquerdo, 46
28007 Madrid
Spain
Tel/Fax: +34 915868276
E-mail address: mmselles{at}secardiologia.es
Department of Cardiology
Hospital Universitario Gregorio Marañón
Dr Esquerdo, 46
28007 Madrid
Spain
Department of Cardiology
Hospital Universitario Gregorio Marañón
Dr Esquerdo, 46
28007 Madrid
Spain
We read with great interest the paper by Sicari et al.1 dealing with the prognostic value of dipyridamole echocardiography test in patients with chest pain syndrome and angiographically normal or near normal coronary arteries and the accompanying editorial by Marwick.2 This study, based in a large cohort with long-term follow-up, shows that dipyridamole echocardiography can identify a subgroup with a less benign prognosis.
Intravenous dipyridamole is a potent coronary vasodilator that has been extensively investigated over the past several years in the non-invasive assessment of patients with suspected coronary artery disease. On the other hand, the ability of dipyridamole to provoke coronary artery spasm in patients with variant angina and angiographically normal coronary arteries is less well known.
Although the mechanisms of dipyridamole-induced coronary artery spasm remain unclear, this ‘false-positive’ test response in patients with normal coronary arteries can be induced by dipyridamole3,4 or by aminophylline.5,6 Aminophylline is a dipyridamole antidote, routinely infused at the end of the test, which produces an abrupt withdrawal of coronary artery vasodilatation which may trigger coronary artery spasms in patients with variant angina.
Fujita et al.7 found a sensitivity of 69% (11 of 16) for dipyridamole echocardiography in patients with coronary artery spasm and normal or nearly normal coronary arteries. Sicari et al.1 and Marwick2 do not mention the ability of dipyridamole echocardiography to provoke coronary artery spasm in patients with normal or near normal coronary arteries and variant angina. However, it is conceivable that the prognostic value of this test could be due, in part, to the detection of patients with spontaneous coronary artery spasm.
References
- Sicari R, Palinkas A, Pasanisi E, Venneri L, Picano E. Long-term survival of patients with chest pain syndrome and angiographically normal or near normal coronary arteries: the additional prognostic value of dipyridamole echocardiography test. Eur Heart J 2005;26:2136–2141. First published on 13 July 2005, doi:10.1093/eurheartj/ehi408.
[Abstract/Free Full Text] - Marwick TH. Ischaemia and outcome with normal coronary arteries. Eur Heart J 2005;26:2077–2078, doi:10.1093/eurheartj/ehi476.
[Free Full Text] - Weinmann P, Le Guludec D, Moretti JL. Coronary spasm induced by dipyridamole during a myocardial scintigraphy. Int J Cardiol 1994;43:75–78.[Medline]
- Sakata K, Nakamura T, Tamekiyo H, Obayashi K, Ishikawa J, Nawada R, Yoshida H, Shirotani M. Pseudoxanthoma elasticum with dipyridamole-induced coronary artery spasm: a case report. Jpn Circ J 1999;63:806–808.[Medline]
- Picano E, Lattanzi F, Masini M, Distante A, L'Abbate A. Aminophylline termination of dipyridamole stress as a trigger of coronary vasospasm in variant angina. Am J Cardiol 1988;62:694–697.[Medline]
- Baldini U, Dini FL, Marchetti M, Micheli G, Magini G. Dipyridamole-echocardiography test in the diagnosis of vasomotor angina. G Ital Cardiol 1997;27:1169–1173.[Medline]
- Fujita H, Yamabe H, Yokoyama M. Dipyridamole-induced reversible thallium-201 defect in patients with vasospastic angina and nearly normal coronary arteries. Clin Cardiol 2000;23:24–30.[Medline]
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