Prognostic value of high dose dipyridamole echocardiography in patients with chronic coronary artery disease and preserved left ventricular function.

Abstract

OBJECTIVES:

The prognostic value of dipyridamole echocardiography was assessed in patients with chronic coronary artery disease and preserved left ventricular function.

BACKGROUND:

Few data are available on the prognostic value of dipyridamole echocardiography in patients with a low risk of cardiac events.

METHODS:

Two hundred sixty-eight consecutive patients with stable, proven or suspected coronary artery disease and ejection fraction > or = 0.40 underwent high dose (up to 0.84 mg/kg body weight) dipyridamole echocardiography. In 204 patients definite exercise electrocardiographic (ECG) results were also available.

RESULTS:

During a mean (+/- SD) follow-up period of 16 +/- 8 months (range 6 to 36), 33 spontaneous events occurred: 15 "hard" events (cardiac death [n = 6], myocardial infarction [n = 9]) and 18 "soft" events (unstable angina). Events occurred more frequently in patients with positive findings on dipyridamole echocardiography (59% vs. 3%, p < 0.001; hard events 24% vs. 2%, p < 0.01). A positive response at the low dose (up to 0.56 mg/kg) identified patients with a high incidence of hard events (7 of 16 patients, sensitivity 50%, specificity 96%). In patients with an exercise ECG, a comparable sensitivity for cardiac events was found (89% vs. 93%, p = NS), but dipyridamole echocardiography was more specific (91% vs. 61%, p < 0.01). A positive response on the low work load exercise ECG (< 8 min) and a positive response to low dose dipyridamole echocardiography had similar accuracy (82% vs. 90%, p = NS). Cox analysis identified dipyridamole echocardiography as the best predictor of cardiac events (odds ratio [OR] 20.9, 95% confidence interval [CI] 10.8 to 37.9); the highest risk of hard events was found in patients with a positive response to low dose dipyridamole echocardiography (OR 25.4, 95% CI 12.2 to 54.1).

CONCLUSIONS:

In patients with chronic coronary artery disease and a low incidence of cardiac events, dipyridamole echocardiography was effective in prognostic stratification, and positive low work load exercise ECG results were a reliable predictor of subsequent events. Consequently, dipyridamole echocardiography should be considered a complementary tool in the presence of high work load positivity or ambiguous exercise ECG results.

• Authors: C Coletta, A Galati, G Greco, M Burattini, R Ricci, A Carunchio, M S Fera, L Bordi, V Ceci
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 26 Issue 4 Pg. 887-94 (Oct 1995) ISSN: 0735-1097 [Print] United States
• PMID: 7560613 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Vasodilator Agents
• Dipyridamole

Topics

• Coronary Disease (diagnosis, diagnostic imaging, epidemiology)
• Dipyridamole
• Echocardiography (methods)
• Electrocardiography
• Exercise Test
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Risk Factors
• Sensitivity and Specificity
• Time Factors
• Vasodilator Agents
• Ventricular Function, Left (physiology)