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Type: Journal article
Title: Tachycardic vs. pharmacologic stress myocardial perfusion imaging: differential implications in multi-vessel ischemia
Author: Nguyen, T.
Horowitz, J.
Unger, S.
Citation: American Journal of Cardiovascular Disease, 2012; 2(1):34-42
Publisher: e-Century Publishing Corporation
Issue Date: 2012
ISSN: 2160-200X
Statement of
Thanh H Nguyen, John D Horowitz, Steven A Unger
Abstract: Background: In patients unable to exercise, potential methods of induction of reversible myocardial ischemia include physiological heart rate acceleration via pacing or dobutamine infusion and asymmetric coronary vasodilatation using dipyridamole. Although their bases for induction of ischemia are widely disparate, no direct comparison of these techniques has previously been reported. Methods: We performed a randomised, paired comparison of dipyridamole and pacing myocardial perfusion imaging (MPI) in 28 patients in whom exercise stress imaging was precluded, comparing the detection, localisation and quantitation of ischemia. Results: Reversible myocardial ischemia was detected in 21 patients, concordantly in 13 (p = 0.042). There was a high degree of concordance (p < 0.0001) regarding locations of sites of ischemia. While there was a good correlation (r = 0.74, p < 0.0001) between size of total ischemic zones with dipyridamole and pacing, the magnitude of ischemia tended to be greater with dipyridamole (mean percentage of left ventricular my¬ocardium ± SD, 9.4 ± 11.0% vs. 7.0 ± 9.0%, p = 0.091). Furthermore, this difference resulted from accentuation of the primary ischemic zone with dipyridamole in pa¬tients with multi-vessel ischemia (mean ± SD, 28.1 ± 21.1% vs. 18.7 ± 16.1%, p = 0.046). Conclusions: Despite major differences in mechanism(s) of induction of ischemia, dipyridamole and pacing produce similar results regarding detection, localisation and severity of ischemia. However, dipyridamole accentuates ischemia in primary (vs. sec¬ondary) ischemic zones, consistent with known induction of coronary "steal". This should be taken into account in interpretation of scan results. (AJCD1110002).
Keywords: Dipyridamole; pacing; myocardial perfusion imaging; coronary
Rights: Copyright status unknown
RMID: 0020127706
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