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PubMed1988

Quantitative thallium-201 single photon emission computed tomography after oral dipyridamole for assessing the presence, anatomic location and severity of coronary artery disease.

The objective of this investigation was to determine whether analysis of thallium-201 images as detected by quantitative single photon emission computed tomography after a single high oral dose of dipyridamole (300 mg) would accurately detect the presence of coronary artery disease and the anatomic location of the individual stenosis. Analyses were performed on 100 patients who concomitantly underwent diagnostic coronary arteriography and myocardial imaging. Tomographic myocardial perfusion defects were quantified using computer-generated polar maps. Eighty-four patients had significant coronary artery disease defined as greater than 50% luminal diameter stenosis. The sensitivity for detecting patients with coronary disease was 92% overall, 89% in patients without previous myocardial infarction and 97% in those with prior infarction. The technique had a sensitivity of 80, 87 and 51% for localizing coronary artery stenosis of the left anterior descending, the right coronary and the left circumflex artery, respectively. The corresponding specificity was 84, 92 and 92%. Furthermore, the presence of severe (greater than or equal to 70%) multivessel disease was identified with a sensitivity of 79% and a specificity of 87%. In conclusion, quantitative thallium-201 single photon emission computed tomography after oral dipyridamole has high sensitivity and specificity for diagnosing the presence of coronary disease, ascertaining the location of stenosed vessels and identifying the presence of multivessel disease.

Administration, Oral↗

PubMed1993

[Value of thallium-dipyridamole myocardial scintigraphy in coronary patients in non cardiac surgery].

Cardiac assessment is of particular importance in patients with documented or suspected coronary artery disease (CAD) as well as in all those patients undergoing vascular surgery. Use of dipyridamole thallium scintigraphy (DTS) in this population could help to detect significant coronary artery narrowing, together with the location and quantification of the areas of myocardium in jeopardy. Such information might lead to changing the surgical procedure, or to starting other treatment, such as coronary angioplasty or bypass graft surgery, thereby diminishing the morbidity and mortality associated with surgery in these high-risk patients. The ability of DTS to predict acute postoperative ischaemic events has been suggested by several studies. Various shortcomings of DTS used as a preoperative screening test have been pointed out in some recent papers. Therefore it is concluded that: 1) DTS should not be used as a routine preoperative test in vascular surgical patients. DTS is not accurate enough when used in patients without any clinical findings suggestive of CAD, 2) DTS may prove more useful in stratifying patients with an intermediate probability of developing cardiac complications. In such patients, the test will not provide a linear "all or nothing" result, but, when taken together with the clinical findings and the nature of the surgical procedure, a complex stratification, 3) Because of progress in the perioperative management of high-risk patients, positive findings on preoperative DTS may not correlate perfectly with perioperative cardiac events, 4) As several factors influence thallium uptake after dipyridamole, DTS does not have a perfect specificity, thus leading to order an excessive number of coronary angiographies. Some patients will be seen as having a false-positive DTS, 5) Preoperative screening DTS leads to cardiac catheterization and hence to revascularisation, independently of symtomatology. Further studies must be undertaken to determine whether this approach will improve short and long term patient survival.

Coronary Disease↗

PubMedDate not supplied

Evaluation of the extent and timing of the coronary hyperemic response to dipyridamole: a study with transesophageal echocardiography and positron emission tomography with oxygen 15 water.

Coronary flow reserve may be measured with Doppler-derived coronary blood-flow velocity or scintigraphic assessment of myocardial perfusion. The purpose of this study was to compare coronary flow velocity and perfusion measures of flow reserve with respect to their extent and time course. Coronary flow velocity reserve in the proximal left anterior descending coronary artery measured by pulsed-wave Doppler at transesophageal echocardiography, with measures of perfusion reserve obtained in the corresponding territory, were measured by a standard O15 water technique at positron emission tomography. Eighteen male volunteers underwent both tests on different days in random order, with dipyridamole stress (0.56 mg/kg). After correction of resting flow and perfusion measurements to a standard cardiac workload (to compensate for heterogeneity in hemodynamics between the two studies), coronary flow reserve was calculated as the ratio between dipyridamoleand corrected resting flow. The uncorrected perfusion reserve measured by positron emission tomography was 3.7 +/- 1.2, compared with a corrected perfusion reserve of 2.3 +/- 0.7. This correlated with a corrected flow velocity reserve of 2.9 +/- 1.0 at transesophageal echocardiography (R = 0.92; p < 0.001). The mean difference between these results was 0.58 +/- 0.41; discrepant results occurred at higher flows, in the presence of discordant blood pressure responses to stress, and because of intersubject variations in the timing of the peak coronary flow response, which were detected by continuous monitoring at transesophageal echocardiography. Measurement of coronary flow reserve at transesophageal echocardiography correlates well with measurements at positron emission tomography, and discrepancies are minimized if measurements are taken at the same time after dipyridamole.

Adult↗

PubMed1999

Assessment of flow mismatch with pharmacologic stress test on myocardial contrast echocardiography in a model of critical stenosis: adenosine triphosphate and dipyridamole.

Although adenosine triphosphate (ATP) is a favorable vasodilator because of its short-acting duration, the agent's effectiveness in facilitating the diagnosis of myocardial ischemia with myocardial contrast echocardiography (MCE) is not fully understood. The goal of this study was to examine the efficacy of intravenous ATP administration (0.15 to 0.30 mg/kg/min for 5 minutes) in diagnosing the flow mismatch with MCE. To achieve this, a critical stenosis was produced in the left circumflex artery in 10 anesthetized dogs. The peak intensity ratio of risk area to control area was reduced by ATP from 0.51 +/- 0.19 to 0.31 +/- 0.12 (P <.05). Systolic wall thickening of the risk area did not change significantly (32.8% +/- 9.8% to 27.5% +/- 12.8%). These changes did not differ from those obtained after dipyridamole. We conclude that MCE with intravenous ATP administration is as useful as the dipyridamole method for diagnosing critical coronary stenosis.

Adenosine Triphosphate↗

PubMed2002

Discordance between dipyridamole stress technetium-99m tetrofosmin single photon emission computed tomography and coronary angiography in patients with Kawasaki disease.

Kawasaki disease (KD) is an acute vasculitis syndrome of unknown etiology that mainly affects the coronary arteries. The purpose of this study was to assess the agreement between dipyridamole stress technetium-99m tetrofosmin (Tc-TF) myocardial perfusion single photon emission computed tomography (SPECT) and coronary angiography in these patients. Twenty-nine children with KD were included in this study. All of the 29 children also received dipyridamole stress Tc-TF myocardial perfusion SPECT within 1 month of their coronary angiographic studies. The results showed that (1) 89.7% of children had negative coronary angiographic findings without significant coronary stenoses, and 10.3% of children had positive coronary angiographic findings with significant coronary stenosis; (2) 44.8% of children had negative Tc-TF myocardial perfusion SPECT findings without abnormal myocardial perfusion, and 55.2% of children had positive Tc-TF myocardial perfusion SPECT findings with abnormal myocardial perfusion; (3) 44.8% of children had both normal coronary angiographic and Tc-TF myocardial perfusion SPECT findings, and 10.3% of children had both abnormal coronary angiographic and Tc-TF myocardial perfusion SPECT findings; and (4) There was no significant agreement between coronary angiographic and Tc-TF myocardial perfusion SPECT findings. We concluded that poor agreement exists between coronary angiographic and Tc-TF myocardial perfusion SPECT findings with coronary stenoses and abnormal myocardial perfusion in children with KD.

Adolescent↗

PubMed1988

Dipyridamole in the treatment of angina pectoris: a meta-analysis.

A meta-analysis was performed to reevaluate the efficacy of dipyridamole for prophylaxis of angina pectoris. We found 10 articles that reported 11 randomized control trials published between 1960 and 1970. Three trials found a statistically significant benefit for the drug vs placebo, four showed a positive trend, two found no difference, and two showed a slight trend favoring placebo. When the results of all 11 trials were combined, two different statistical methods showed a statistically significant benefit from the drug. These combined results must be interpreted cautiously because of excluded patients and other methodologic variations in the studies, as well as evidence from other studies that dipyridamole may aggravate angina. Nevertheless, we conclude that there is some evidence for efficacy of the drug and believe the question should be restudied in larger and better-designed trials.

Angina Pectoris↗

PubMed1997

Phosphorimetric determination of dipyridamole in pharmaceutical preparations.

Room temperature phosphorescence was applied to the determination of dipyridamole in pharmaceutical preparations. The response was linear in the concentration range 100-1600 ng ml-1. The use of phosphorescence enhancers such as thallium(I) nitrate (external heavy atom), sodium dodecyl sulfate (microemulsion stabilizer) and sodium sulfite (deoxygenation agent) was studied and optimized to obtain maximum sensitivity and adequate selectivity. The determination was performed in 0.026 M sodium dodecyl sulfate, 0.0156 M thallium nitrate and 0.02 M sodium sulfite. The pH value was 11.5, adjusted by adding sodium hydroxide. The phosphorescence was totally developed in 15 min, after that the intensity was measured at lambda ex = 303 nm and lambda em = 616 nm. The recovery of the method was tested on commercial formulations containing dipyridamole. The recoveries obtained were 94.67 +/- 0.58% for Persantin and 96.75 +/- 1.37% for Asasantin. The overall least squares regression method was applied to find the most exact straight line that fits the experimental data. The detection limit according to the error propagation theory was 16.4 ng ml-1. The repeatability and relative standard deviation were also determined according to this theory.

Dipyridamole↗

PubMed1996

Red blood cell aggregability is increased by aspirin and flow stress, whereas dipyridamole induces cell shape alterations: measurements by digital image analysis.

We evaluated the influence of pretreatment with aspirin in vitro, alone or combined with dipyridamole, on red cell aggregability. Samples were tested before and after being exposed to well-defined flow conditions. An aggregation rate was estimated through digital analysis of light microscopy images. Red cells of untreated blood that had been exposed to flow showed a higher aggregation rate (38.54 +/- 1.63 vs. 27.52 +/- 1.36; P < 0.05). This effect was not observed in the absence of platelets. Treatment with aspirin induced a high aggregation rate, with or without exposure to flow conditions. Dipyridamole alone or combined with aspirin provoked echinocytosis, disturbing the rouleaux arrangement (rates ranging from 11.25 +/- 1.91 - 13.62 +/- 1.62). Washing red cells after treatment restored about 90% of echinocytes to their biconcave shape, but aggregation rate did not recover in parallel. These results highlight the influence of red cell-platelet interactions in the regulation of haemostasis and show how therapeutic agents can interfere with rheological phenomena.

Aspirin↗

PubMed2003

Treatment of Kasabach-Merritt syndrome: a stepwise regimen of prednisolone, dipyridamole, and interferon.

BACKGROUND: Kasabach-Merritt syndrome (KMS) is a rare, aggressive, vascular tumor with thrombocytopenia and consumptive coagulopathy. A standard treatment regimen for KMS has not been established. We reviewed our experience of a stepwise approach for the treatment of 10 children with KMS. METHODS: All patients were first treated with oral corticosteroid (initially 3 mg/kg/day then 5 mg/kg/day) and dipyridamole. Interferon-alpha-2b (IFNalpha2b) was used as second therapy for steroid-resistant cases for 12 months, then tapered to an alternate-day regimen, and then discontinued. Adjunctive therapy, including embolization of the feeding vessel or chemotherapy, was additionally used in patients who failed to respond to IFN or could not be taken off IFN. RESULTS: Ten patients were treated on this protocol with a follow-up time of 1-6 years. Oral corticosteroid plus dipyridamole was successful in four patients, but was tapered off by 12 months without recurrence in only two cases. Of the eight steroid-resistant cases, IFNalpha2b successfully induced regression of the tumor and increased the platelet count in six patients; however, IFNalpha2b was successful as monotherapy in only three cases; two patients died of aspiration pneumonia whilst on therapy and one patient could not be taken off IFNalpha2b until weekly vincristine was given (eight doses). Two other patients did not respond to IFNalpha2b in 4 weeks; embolization and vinblastine was used in one patient to induce regression of the tumor and resolution of thrombocytopenia. Hypertension developed in all children on high-dose prednisolone. CONCLUSIONS: KMS may be treated in a stepwise approach. High-dose steroid does not result in a high response rate and is not tolerated well. The response to IFNalpha2b is more favorable, but life-threatening adverse events may occur. Chemotherapy with vincristine or vinblastine may be useful as adjunctive therapy in KMS, but experience is still limited.

Abnormalities, Multiple↗

PubMed2000

Adenosine- and adenine-nucleotide-mediated inhibition of normal and transformed keratinocyte proliferation is dependent upon dipyridamole-sensitive adenosine transport.

Extracellular adenosine and its related nucleotides have been referred to as retaliatory metabolites that can be released into the extracellular environment during inflammation, wounding, and other pathologic states. We have previously reported that these compounds reversibly inhibit the proliferation of normal keratinocyte cultures and we now demonstrate that these compounds also arrest the proliferation of transformed keratinocytes. Although our study shows that keratinocytes express mRNA corresponding to the A2B purinoreceptors and that adenosine or AMP treatment elevates intracellular cAMP in these cells, our study also demonstrates that dipyridamole-inhibitable transport of adenosine into the keratinocyte is central to the mechanism by which adenosine and adenine nucleotides arrest proliferation in these cells. In support of this mechanism, our results demonstrate that human keratinocytes express mRNA corresponding to the recently cloned dipyridamole-sensitive human equilibrative nucleoside transporter. Interestingly, coincubation with adenosine deaminase reverses the antiproliferative action of adenosine and exerts no effect on the antiproliferative activity of the adenine nucleotides, thus supporting a model in which adenine nucleotides are enzymatically converted to adenosine and transported into the keratinocyte in a tightly coupled and adenosine-deaminase-resistant manner. Analysis of adenosine- and adenosine-monophosphate-treated keratinocytes demonstrated that quiescence is induced within 12-24 h, and fluorescence-activated cell sorter analysis suggests that treatment with these compounds may result in the inhibition of keratinocyte proliferation at both G1 and S phases of the cell cycle. In addition to their documented antiproliferative action on other cell types, adenosine, adenine nucleotides, and related analogs may also represent a potential new class of pharmacologic regulators of keratinocyte proliferation in vivo.

Adenine Nucleotides↗

PubMed2001

Dipyridamole inhibits human peritoneal mesothelial cell proliferation in vitro and attenuates rat peritoneal fibrosis in vivo.

BACKGROUND: Peritoneal fibrosis (PF) is one of the most serious complications after long-term continuous ambulatory peritoneal dialysis (CAPD). Proliferation of human peritoneal mesothelial cells (HPMC) and matrix over-production are regarded as the main processes predisposing to PF. Dipyridamole (DP) has been reported to have potential as an antiproliferative and antifibrotic agent. We thus investigated the effect of DP in inhibiting proliferation and collagen synthesis of HPMC. A rat model of peritonitis-induced PF was also established to demonstrate the in vivo preventive effect of DP. METHODS: HPMC was cultured from human omentum by an enzyme digestion METHOD: Cell proliferation was measured by the methyltetrazolium assay. Intracellular cAMP was measured using an enzyme immunoassay (EIA) kit. Total collagen synthesis was measured by (3)H-proline incorporation assay. Expression of collagen alpha1 (I) and collagen alpha 1 (III) mRNAs was determined by Northern blotting. The rat model of peritonitis-induced PF was developed by adding dextran microbeads (Cytodex, 8 mg/1 mL volume) to a standardized suspension (3 x 10(9)) of Staphylococcus aureus. DP was administrated via intravenous infusion (4 mg in 1 h) daily for seven days. Macroscopic grading of intraperitoneal adhesions and histological analyses of peritoneal thickness and collagen expression were performed. RESULTS: Addition of DP to HPMC cultures suppressed serum-stimulated cell proliferation and collagen synthesis. The antimitogenic and antifibrotic effects of DP appear to be predominantly mediated through the cAMP pathway, as DP increased intracellular cAMP in a dose-dependent manner. The macroscopic grade of intraperitoneal adhesion and peritoneal thickness were both significantly increased in animals treated with Cytodex plus S. aureus; on the other hand, DP attenuated these fibrotic changes with statistical significance (P < 0.01). Analysis of gene expression of collagen alpha 1 (I) and alpha1 (III) in the peritoneal tissue of experimental animals yielded similar results. CONCLUSIONS: This study suggests that dipyridamole may have therapeutic potential in treating peritoneal fibrosis.

Animals↗

PubMed2002

Combined dipyridamole-exercise stress echocardiography for detection of myocardial ischemia in hemodialysis patients: an alternative to stress nuclear imaging.

BACKGROUND: Stress nuclear imaging is the noninvasive technique currently used to detect coronary artery disease (CAD) in dialysis patients. Stress echocardiography is recognized as an alternative to stress nuclear imaging for the general population. The aim of this study is to assess the diagnostic accuracy of stress echocardiography for detecting myocardial ischemia in hemodialysis patients. METHODS: Stress echocardiography and stress technetium-99m-tetrofosmin (Myoview; Amersham International Plc) imaging were performed simultaneously for 66 asymptomatic hemodialysis patients in a single session, using a combination of high-dose dipyridamole and symptom-limited exercise. Coronary angiography was performed in 44 patients with at least one abnormal noninvasive test result or who were considered high-risk despite normal noninvasive test results. RESULTS: Results for stress echocardiography were abnormal in 15 patients (22%); stress Myoview, in 14 patients (21%); and coronary angiography, in 12 patients (18%). The sensitivity of stress echocardiography for detecting myocardial ischemia (defined as stress Myoview defect) was 86%; specificity, 94%; positive predictive value, 80%; negative predictive value, 96%; and overall accuracy, 92%. The sensitivity of stress echocardiography for detecting CAD (defined as abnormal coronary angiography result) was 83%; specificity, 84%; positive predictive value, 67%; negative predictive value, 93%; and overall accuracy, 84%. Stress echocardiography and stress Myoview did not differ significantly in overall accuracy for detecting CAD (84% versus 91%; P = not significant). CONCLUSION: In hemodialysis patients, combined dipyridamole-exercise echocardiography is an accurate method to detect both myocardial ischemia and CAD and represents an alternative to stress nuclear imaging.

Adult↗

PubMed2001

Resting echocardiography and quantitative dipyridamole technetium-99m sestamibi tomography in the identification of cardiac allograft vasculopathy and the prediction of long-term prognosis after heart transplantation.

AIMS: To evaluate the accuracy of echocardiography in conjunction with quantitative high-dose dipyridamole technetium-99m sestamibi tomography (SPECT) in detecting coronary allograft vasculopathy. METHODS AND RESULTS: Seventy-eight consecutive heart transplant recipients underwent echocardiography while at rest and high-dose dipyridamole SPECT within 48 h of a yearly angiogram. Resting wall motion abnormalities were considered significant if present in two or more segments. SPECT was considered abnormal in the presence of reversible/fixed defects. The coronary angiogram was normal in 53, showed non-significant coronary allograft vasculopathy in 13 and significant (> or = 50% stenosis) coronary allograft vasculopathy in 12 cases. Resting wall motion abnormalities were observed in nine cases and perfusion defects in 20. Echocardiography and SPECT were concordant in 59 cases (five positive and 54 negative); in these, accuracy was 100% for significant coronary allograft vasculopathy and 83% for any coronary allograft vasculopathy. Over 6.5+/-2 years, 17 patients suffered coronary allograft vasculopathy-related events, including death in six and retransplantation in three. Resting wall motion abnormalities, SPECT perfusion defects and angiographic coronary allograft vasculopathy were significant predictors of cardiac events. CONCLUSION: Normal resting wall motion at echocardiography coupled to normal stress myocardial perfusion, rules out the presence of significant coronary allograft vasculopathy in many heart transplant recipients. Conversely, resting wall motion abnormalities and perfusion defects strongly predict cardiac events. Therefore, a strategy which reserves angiography for patients with resting wall motion abnormalities and/or perfusion defects may be safe and cost-effective.

Adolescent↗

PubMed1997

Recurrence of biliary drug lithiasis due to dipyridamole.

The occurrence of drug-containing gallstones is not often observed. To our knowledge, three drugs have so far been incriminated-ceftriaxone, glaphenine, and dipyridamole. This report presents the case of an 85-year-old woman who developed a recurrent drug-containing gallstone caused by dipyridamole eighteen months after a previous stone had been removed endoscopically.

Aged↗

PubMed1987

Reduction of exercise-induced albuminuria by aspirin-dipyridamole in patients with diabetes mellitus.

The exercise-induced increase in albumin excretion was measured in six patients with insulin-dependent diabetes mellitus, in whom there was no evidence of established diabetic renal disease. Urinary albumin excretion was measured on urine samples taken at rest and immediately after a 20 minute period of exercise on a bicycle ergometer at 600 kpm/min. Following a three week course of aspirin (330 mg)--dipyridamole (75 mg) taken three times daily there was significant reduction in exercise-induced albuminuria (expressed as the ratio of albumin excretion rate during exercise to that at rest before exercise) when compared to administration of placebo (P less than 0.05). These results suggest that aspirin-dipyridamole might modify the development of persistent proteinuria in patients with insulin-dependent diabetes mellitus.

Adult↗

PubMed1982

A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency.

To prevent occlusion of aortocoronary-artery-bypass grafts, we conducted a prospective, randomized-double-blind trial comparing dipyridamole (instituted two days before operation) plus aspirin (added seven hours after operation) with placebo in 407 patients. Vein-graft angiography was performed in 360 patients (88 per cent) within six months of operation (median, eight days). Within one month of operation, 3 per cent of vein-graft distal anastomoses (10 of 351) were occluded in the treated patients, and 10 per cent (38 of 362) in the placebo group; the proportion of patients with one or more distal anastomoses occluded was 8 per cent (10 of 130) in the treated group and 21 per cent (27 of 130) in th placebo group. This benefit in graft patency persisted in each of over 50 subgroups. Early postoperative bleeding was similar in the two groups. In this trial dipyridamole and aspirin were effective in preventing graft occlusion early after operation.

Adult↗

PubMed1985

Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery.

To evaluate the severity of coronary artery disease in patients with severe peripheral vascular disease requiring operation, we performed preoperative dipyridamole-thallium imaging in 54 stable patients with suspected coronary artery disease. Of the 54 patients, 48 had peripheral vascular surgery as scheduled without coronary angiography, of whom 8 (17 per cent) had postoperative cardiac ischemic events. The occurrence of these eight cardiac events could not have been predicted preoperatively by any clinical factors but did correlate with the presence of thallium redistribution. Eight of 16 patients with thallium redistribution had cardiac events, whereas there were no such events in 32 patients whose thallium scan either was normal or showed only persistent defects (P less than 0.0001). Six other patients also had thallium redistribution but underwent coronary angiography before vascular surgery. All had severe multivessel coronary artery disease, and four underwent coronary bypass surgery followed by uncomplicated peripheral vascular surgery. These data suggest that patients without thallium redistribution are at a low risk for postoperative ischemic events and may proceed to have vascular surgery. Patients with redistribution have a high incidence of postoperative ischemic events and should be considered for preoperative coronary angiography and myocardial revascularization in an effort to avoid postoperative myocardial ischemia and to improve survival. Dipyridamole-thallium imaging is superior to clinical assessment and is safer and less expensive than coronary angiography for the determination of cardiac risk.

Aged↗

PubMedDate not supplied

Discordance between dipyridamole stress Tc-99m sestamibi SPECT and coronary angiography in patients with Kawasaki disease.

BACKGROUND: Kawasaki disease is an acute vasculitis syndrome of unknown etiology that mainly affects the coronary arteries. The purpose of this study was to assess the agreement between dipyridamole stress technetium 99m sestamibi single photon emission computed tomography (SPECT) and coronary angiography in these patients. METHODS AND RESULTS: Forty-one consecutive patients (29 boys and 12 girls) who underwent coronary angiography were studied prospectively. Their ages at onset of the disease ranged from 2 months to 4.8 years (mean +/- SD, 1.9 +/- 1.3 years). Their ages at the time of the study ranged from 8 months to 15.3 years (6.2 +/- 4.4 years). The duration between symptom onset and the study ranged from 2 months to 12 years (4.3 +/- 4.0 years). All patients underwent dipyridamole stress Tc-99m sestamibi SPECT within 1 month of their angiographic studies. They were divided into 3 groups according to coronary angiography findings. Group A consisted of 2 patients (1 boy and 1 girl, aged 10.3 and 1.9 years, respectively) with coronary stenoses who also had aneurysms. Group B consisted of 10 patients (8 boys and 2 girls, aged 0.7-15.3 years [mean, 3.8 years]) with coronary aneurysms. Group C consisted of 29 patients (20 boys and 9 girls, aged 1.2-13.8 years [mean, 7 years]) with normal coronary angiograms. Two patients in group A (100%), 3 of 10 patients in group B (30%), and 19 of 29 patients in group C (65.5%) had myocardial perfusion defects. There was poor agreement between Tc-99m sestamibi SPECT and coronary angiography for detecting coronary stenoses (kappa = 0.07; P =.222) and aneurysms (kappa = -0.184; P =.158). CONCLUSION: Significant discordance exists between Tc-99m sestamibi SPECT and coronary angiography in patients with Kawasaki disease.

Adolescent↗