Mechanism of inducible regional dysfunction during dipyridamole stress.

Abstract

BACKGROUND:

We hypothesized that increased myocardial oxygen demand resulting from hypotension and reflex tachycardia unmasking a reduced endocardial myocardial blood flow (MBF) reserve is the mechanism of dipyridamole-induced regional dysfunction in chronic coronary artery disease.

METHODS AND RESULTS:

Ameroid constrictors were placed around the proximal coronary arteries and their major branches in 15 dogs to create chronic coronary stenosis. Seven days later, radiolabeled microsphere-derived MBF and 2-dimensional echocardiography-derived percent wall thickening (%WT) were measured at rest and after 0.56 mg/kg dipyridamole. Dipyridamole caused an increase (mean, 21%) in the rate-pressure product secondary to reflex tachycardia resulting from mild systemic hypotension. %WT in myocardial segments with an endocardial MBF reserve (dipyridamole/resting MBF) of 1.5 to 2.5 (n=35) did not change after dipyridamole, whereas it decreased in segments with an endocardial MBF reserve of <1.5 (n=30) and increased in those with an endocardial MBF reserve of > or =2.5 (n=45) (P<0.05). Most (80%) segments with endocardial MBF reserve of <1.5 and 14% with an endocardial MBF reserve of 1.5 to 2.5 showed inducible dysfunction after dipyridamole, whereas none of the segments with an endocardial MBF reserve of > or =2.5 showed this finding. A sigmoid relation (y=-6.74/[1+exp (19.9. [x-1.84])]+1.35. x, r=0.93, P<0.0001) was noted between endocardial MBF reserve and Delta%WT. In contrast, neither the epicardial MBF reserve nor the endocardial/epicardial MBF ratio during hyperemia was associated with inducible regional dysfunction.

CONCLUSIONS:

Increased myocardial oxygen demand resulting from hypotension and reflex tachycardia unmasking a reduced endocardial MBF reserve is the primary mechanism of dipyridamole-induced regional dysfunction in chronic coronary artery disease.

• Authors: Jian-Ping Bin, Elizabeth Le, Robert A Pelberg, Matthew P Coggins, Kevin Wei, Sanjiv Kaul
• Journal: Circulation (Circulation) Vol. 106 Issue 1 Pg. 112-7 (Jul 02 2002) ISSN: 1524-4539 [Electronic] United States
• PMID: 12093779 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Vasodilator Agents
• Dipyridamole

Topics

• Animals
• Blood Pressure (drug effects)
• Coronary Circulation (drug effects)
• Coronary Stenosis (diagnostic imaging, physiopathology)
• Dipyridamole (pharmacology)
• Dogs
• Echocardiography, Stress
• Endocardium (diagnostic imaging, physiopathology)
• Hemodynamics (drug effects)
• Pericardium (diagnostic imaging, physiopathology)
• Regional Blood Flow (drug effects)
• Tachycardia (chemically induced)
• Vasodilator Agents (pharmacology)