Tachycardic vs. pharmacologic stress myocardial perfusion imaging: differential implications in multi-vessel ischemia

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dc.contributor.authorNguyen, T.
dc.contributor.authorHorowitz, J.
dc.contributor.authorUnger, S.
dc.date.issued2012
dc.description.abstractBackground: 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).
dc.description.statementofresponsibilityThanh H Nguyen, John D Horowitz, Steven A Unger
dc.identifier.citationAmerican Journal of Cardiovascular Disease, 2012; 2(1):34-42
dc.identifier.issn2160-200X
dc.identifier.issn2160-200X
dc.identifier.orcidNguyen, T. [0000-0002-8244-8655]
dc.identifier.orcidHorowitz, J. [0000-0001-6883-0703]
dc.identifier.urihttp://hdl.handle.net/2440/77992
dc.language.isoen
dc.publishere-Century Publishing Corporation
dc.rightsCopyright status unknown
dc.source.urihttp://www.ajcd.us.proxy.library.adelaide.edu.au/files/AJCD1110002.pdf
dc.subjectDipyridamole
dc.subjectpacing
dc.subjectmyocardial perfusion imaging
dc.subjectcoronary
dc.titleTachycardic vs. pharmacologic stress myocardial perfusion imaging: differential implications in multi-vessel ischemia
dc.typeJournal article
pubs.publication-statusPublished

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