Lattanzi F, Picano E, Bolognese L, Piccinino C, Sarasso G, Orlandini A, L'Abbate A
C.N.R. Clinical Physiology Institute, University of Pisa, Italy.
Circulation. 1991 Apr;83(4):1256-62. doi: 10.1161/01.cir.83.4.1256.
Dipyridamole echocardiography test (DET: two-dimensional echocardiographic monitoring with dipyridamole infusion up to 0.84 mg/kg in 10 minutes) is a useful tool for the noninvasive diagnosis of coronary artery disease. Aims of the present study were to assess the effects of antianginal drugs on dipyridamole-induced ischemia and to evaluate whether drug-induced changes in DET response may predict variations in exercise tolerance.
Fifty-seven patients with angiographically assessed significant coronary artery disease (greater than 70% lumen reduction in at least one major coronary vessel) performed a DET and an exercise electrocardiography test (EET) in random order both off treatment and on antianginal drugs (beta-blockers, calcium antagonists and nitrates, alone or in various combinations). The criterion for DET positivity was a transient dyssynergy of contraction absent or of a lesser degree in the baseline examination. In DET, two parameters were evaluated: the dipyridamole time (i.e., the time from onset of dipyridamole infusion to obvious dyssynergy) and the wall motion score index. DET sensitivity was 91% off therapy and fell to 65% under therapy (p less than 0.01). In the 37 patients who had a positive DET both off and on therapy, the dipyridamole time increased from 6 +/- 3 (off therapy) to 8 +/- 3 minutes (on therapy) (p less than 0.01). The wall motion score index at peak dipyridamole went from 1.38 +/- 0.14 to 1.31 +/- 0.14 (p less than 0.01). EET and DET yielded concordant (positive versus negative) results in 41 of 57 (71%) patients off and in 35 of 57 (61%) on therapy (p = NS). In the subgroup of 38 patients with both positive DET and EET without treatment, the therapy-induced variations in exercise time were significantly correlated with the variations in dipyridamole time (r = 0.5; p less than 0.01), not with variations in wall motion score index (r = 0.3; p = NS).
双嘧达莫超声心动图试验（DET：静脉输注双嘧达莫，剂量达0.84mg/kg，10分钟内完成，同时进行二维超声心动图监测）是冠状动脉疾病无创诊断的一项有用工具。本研究的目的是评估抗心绞痛药物对双嘧达莫诱发的心肌缺血的影响，并评估药物引起的DET反应变化是否可预测运动耐量的改变。
57例经血管造影评估患有严重冠状动脉疾病（至少一支主要冠状动脉血管腔径缩小大于70%）的患者，在未接受治疗和接受抗心绞痛药物（β受体阻滞剂、钙拮抗剂和硝酸盐类，单独或联合应用）治疗时，随机先后进行DET和运动心电图试验（EET）。DET阳性标准为基线检查时无或仅有较轻程度的短暂收缩不协调。在DET中，评估两个参数：双嘧达莫时间（即从开始输注双嘧达莫至出现明显不协调的时间）和室壁运动评分指数。未治疗时DET敏感性为91%，治疗时降至65%（p<0.01）。在37例治疗前后DET均为阳性的患者中，双嘧达莫时间从未治疗时的6±3分钟增加至治疗时的8±3分钟（p<0.01）。双嘧达莫峰值时的室壁运动评分指数从1.38±0.14降至1.31±0.14（p<0.01）。未治疗时，57例患者中有41例（71%）EET和DET结果一致（阳性或阴性）；治疗时，57例患者中有35例（61%）结果一致（p=无显著性差异）。在38例未治疗时DET和EET均为阳性的亚组患者中，治疗引起的运动时间变化与双嘧达莫时间变化显著相关（r=0.5；p<0.01），与室壁运动评分指数变化无关（r=0.3；p=无显著性差异）。
1）抗心绞痛治疗可预防双嘧达莫诱发的心肌缺血；2）治疗引起的DET反应变化与运动耐量变化平行，可能有助于客观、独立于运动的治疗效果评估。
