Taillefer R, Lette J, Phaneuf D C, Léveillé J, Lemire F, Essiambre R
J Am Coll Cardiol. 1986 Jul;8(1):76-83. doi: 10.1016/s0735-1097(86)80094-8.
Although the diagnostic utility of thallium-201 myocardial imaging after dipyridamole infusion is well established, the intravenous form of the drug is not yet commercially available in North America. Fifty patients referred for coronary angiography were prospectively studied. Within a 2 week period, each patient underwent cardiac catheterization and thallium-201 myocardial imaging after both oral and intravenous dipyridamole administration. For the oral protocol, patients were randomly assigned to treatment with either 200 or 400 mg of dipyridamole in tablet form. Coronary artery stenoses of 70% or greater were considered significant. For the 25 patients who received a 200 mg oral dose of dipyridamole, the scintigraphic study showed perfusion defects in 65% of patients with significant coronary artery disease after the oral dose and in 85% of patients after the intravenous dose. For the 25 patients who received a 400 mg oral dose, the sensitivity of the scintigram was 84% after the oral dose and 79% after the intravenous dose. Except for headache and nausea, side effects were less severe and less frequent with oral (either 200 or 400 mg) than with intravenous dipyridamole. Because of the delayed and variable absorption of dipyridamole tablets, the oral studies required a longer period of medical supervision (45 to 60 minutes), and aminophylline was empirically administered after completion of the first set of thallium-201 images. It is concluded from this study that thallium-201 myocardial imaging after coronary vasodilation with a 400 mg oral dose of dipyridamole is a safe, widely available and reliable alternative for the evaluation of coronary artery disease in patients unable to achieve an adequate exercise level on stress testing.
尽管双嘧达莫静脉注射后进行铊-201心肌显像的诊断效用已得到充分证实，但该药物的静脉注射剂型在北美尚未上市。对50例因冠状动脉造影而转诊的患者进行了前瞻性研究。在2周内，每位患者在口服和静脉注射双嘧达莫后均接受了心导管检查和铊-201心肌显像。对于口服方案，患者被随机分配接受200毫克或400毫克片剂形式的双嘧达莫治疗。70%或更高的冠状动脉狭窄被视为显著狭窄。对于接受200毫克口服剂量双嘧达莫的25例患者，闪烁扫描研究显示，口服剂量后，65%的显著冠状动脉疾病患者出现灌注缺损，静脉注射剂量后，85%的患者出现灌注缺损。对于接受400毫克口服剂量的25例患者，闪烁扫描的敏感性在口服剂量后为84%，静脉注射剂量后为79%。除头痛和恶心外，口服（200毫克或400毫克）双嘧达莫的副作用比静脉注射双嘧达莫更轻且更不常见。由于双嘧达莫片剂吸收延迟且变化不定，口服研究需要更长时间的医学监测（45至60分钟），并且在完成第一组铊-201图像后根据经验给予氨茶碱。从这项该研究得出结论，对于在压力测试中无法达到足够运动水平的患者，口服400毫克双嘧达莫进行冠状动脉扩张后进行铊-201心肌显像是一种安全、广泛可用且可靠的评估冠状动脉疾病的替代方法。
