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European Heart Journal 2001 22(14):1205-1213; doi:10.1053/euhj.2000.2446
Copyright © 2001 by the European Society of Cardiology.
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Effects of dipyridamole on coronary collateralization and myocardial perfusion in patients with ischaemic cardiomyopathy

R Belardinellia,f1, L Belardinellib and J.C Shryockb

a Servizio di Cardiologia Riabilitativa, Azienda Ospedaliera ‘G.M.Lancisi’ Ancona, Italy
b Department of Medicine, University of Gainesville, Florida, U.S.A.

revised August 31, 2000; accepted September 6, 2000

Abstract

Aims There is evidence that oral dipyridamole, a nucleoside uptake blocker that increases myocardial adenosine levels, lessens myocardial ischaemia by inducing coronary collateral growth in animal models of ischaemic heart disease. However, whether dipyridamole can exert a similar effect in humans with coronary artery disease is controversial.

Methods and Results We studied 30 male patients (mean age 55±9 years) with coronary artery disease and left ventricular systolic dysfunction (ejection fraction >40%). Patients were randomized into three matched groups. Group A patients (n=10) received dipyridamole alone at a dose of 75mg t.i.d. orally for 8 weeks. Group B patients (n=10) underwent exercise training at 60% of peak O2three times a week for 8 weeks, and received dipyridamole. Group C patients (n=10) had neither exercise testing nor dipyridamole. On study entry and after 8 weeks all patients underwent an exercise test with gas exchange analysis, dobutamine stress echocardiography, 201-thallium planar myocardial scintigraphy, and coronary angiography. Peak O2increased significantly only in trained patients. Thallium uptake of the collateral-dependent myocardium, coronary collateral score and wall thickening score increased significantly only in groups receiving dipyridamole, the greatest improvement being in group B patients. Plasma adenosine levels were also the highest in group B (P<0·001 vs A and C). Correlations were found between changes in adenosine levels and increases of both thallium uptake (r=–0·70;P=0·001) and collateralization (r=0·72;P=0·001).

Conclusion Exercise training potentiates the effects of dipyridamole on coronary collateralization and myocardial perfusion in humans with ischaemic cardiomyopathy.

Key Words: Dipyridamole, adenosine, myocardial scintigraphy, ischaemic heart disease

f1 Correspondence: Romualdo Belardinelli, MD, Via Rismondo, 5, 60100 Ancona, Italy.

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