Lalonde D, Taillefer R, Lambert R, Bisson G, Basile F, Prieto I, Benjamin C
Department of Nuclear Medicine, Hôtel-Dieu de Montréal, Université de Montréal, Canada.
J Nucl Med. 1994 Aug;35(8):1245-53.
The purpose of this study was to compare two different doses of dipyridamole as a pharmacologic stress test for 201Tl imaging.
Twenty-four patients with significant coronary artery disease (15 had undergone a coronary angiogram and 9 had undergone a previous 201Tl study with a significant lesion) were prospectively studied. Within 1 wk, all patients underwent two 201T-dipyridamole myocardial planar studies, one using a standard dose (STD) and the other, a high dose (HIGH) of dipyridamole. The protocol order was randomly assigned. The STD protocol used a dose of 0.14 mg/kg/min for a duration of 4 min (0.56 mg/kg), and the HIGH protocol used a dose of 0.14 mg/kg min for a duration of 6 min (0.84 mg/kg). The 201Tl was injected 3 min after the end of the dipyridamole infusion. Images, obtained 5 min and 4 hr later, were interpreted (divided into five segments each) by three blinded observers.
The STD protocol showed normal, ischemia and scar in 252, 91 and 17 segments, respectively. The HIGH protocol detected 232, 118 and 10 segments, respectively. A side-by-side evaluation was done to evaluate the defect extent subjectively, which was greater with HIGH in 14, equal in six and smaller in four patients. One or more side effects were seen in 14 patients with STD and in 19 with HIGH. Increased heart rate (8 bpm for STD and 19 bpm for HIGH, p < 0.001) was the only significant change seen in the hemodynamic parameters.
This preliminary study indicates that a high dose of dipyridamole seems to be safe and can be helpful to increase the sensitivity of 201Tl imaging.
本研究的目的是比较两种不同剂量的双嘧达莫作为用于铊-201成像的药物负荷试验。
对24例患有严重冠状动脉疾病的患者进行前瞻性研究（其中15例接受过冠状动脉造影，9例之前进行过铊-201研究且有明显病变）。在1周内，所有患者均接受两次铊-201-双嘧达莫心肌平面显像研究，一次使用标准剂量（STD）双嘧达莫，另一次使用高剂量（HIGH）双嘧达莫。方案顺序随机分配。STD方案使用剂量为0.14mg/kg/分钟，持续4分钟（0.56mg/kg），HIGH方案使用剂量为0.14mg/kg/分钟，持续6分钟（0.84mg/kg）。双嘧达莫输注结束后3分钟注射铊-201。5分钟和4小时后获得的图像由三名不知情的观察者进行解读（每幅图像分为五个节段）。
STD方案显示正常、缺血和瘢痕节段分别为252个、91个和17个。HIGH方案分别检测到232个、118个和10个节段。进行了并排评估以主观评估缺损范围，14例患者中HIGH方案的缺损范围更大，6例患者二者相等，4例患者中HIGH方案的缺损范围更小。STD方案组14例患者和HIGH方案组19例患者出现一种或多种副作用。心率增加（STD方案组增加8次/分钟，HIGH方案组增加19次/分钟，p<0.001）是血流动力学参数中唯一显著的变化。
这项初步研究表明，高剂量双嘧达莫似乎是安全的，并且有助于提高铊-201成像的敏感性。
