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Myocardial ischemia in Kawasaki disease: evaluation with dipyridamole stress technetium 99m tetrofosmin scintigraphy.

BACKGROUND: The coronary artery abnormalities in Kawasaki disease (KD) often cause myocardial ischemia. Previous publications have described the use of thallium 201 myocardial perfusion imaging to determine the extent of ischemia in patients with KD. The technetium perfusion agents offer better resolution and may offer additional information about ventricular function in these patients. This study was performed to evaluate myocardial perfusion in patients with KD through use of technetium 99m tetrofosmin (TF) in conjunction with dipyridamole vasodilator stress. METHODS AND RESULTS: Eighty-six patients with KD aged 11.5 +/- 6.4 years and 20 age-matched control patients without heart disease were studied. Among 86 patients with KD, significant coronary artery stenosis (>or=75%) was observed in 20, coronary aneurysm without stenosis in 37, and no coronary lesions in 29. After administration of high-dose dipyridamole infusion (0.70 mg/kg), 74 to 370 MBq TF was injected and 148 to 740 MBq TF was injected at rest 4 hours later. Single photon emission computed tomography images were obtained more than 30 minutes after TF injection. Regional myocardial hypoperfusion was observed in 18 patients who had coronary artery stenosis of 75% or greater (sensitivity, 90%, and specificity, 100%). Two patients did not demonstrate ischemic changes in coronary artery stenosis in group I; one had good collateral flow. There were no TF injection-related complications. CONCLUSIONS: Tetrofosmin myocardial perfusion imaging can detect regional hypoperfusion in children with KD.

Adolescent↗
PubMed1988

Neoendothelialization of small-diameter polytetrafluoroethylene arterial grafts is not delayed by aspirin and dipyridamole.

The effect of aspirin and dipyridamole on neoendothelialization of polytetrafluoroethylene (PTFE) was studied in the rabbit aortic graft model. Forty-three New Zealand white rabbits were allocated to receive a combination of aspirin 10 mg/kg/day and dipyridamole 10 mg/kg/day (n = 23) or placebo (n = 20). Both regimens began 3 days before insertion of PTFE aortic grafts (10 mm long and 3 mm internal diameter). Serum thromboxane B2 concentration in the control group averaged 254 +/- 22 ng/ml (+/- standard error of the mean) and 40 +/- 23 ng/ml in the treatment group (p less than 0.001). Grafts and adjacent aorta were harvested at 2 weeks (n = 4), 4 weeks (n = 9), 8 weeks (n = 13), and 12 weeks (n = 17) after implantation. Morphologic techniques, including conventional light microscopy, immunoperoxidase staining for endothelial factor VIII-related antigen, and scanning electron microscopy (SEM) demonstrated that neointima was composed of endothelial cells arising by ingrowth at anastomotic site and as islands in the center of the graft. The percentage of graft neoendothelialization was measured by SEM. At 2 weeks 18% +/- 2% of the PTFE surface was covered with endothelium in the aspirin/dipyridamole group. The percentages of graft neoendothelialization for the treatment and control groups at 4 weeks were 44% +/- 13% (n = 5) and 46% +/- 10% (n = 4) (p = NS), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Multivariate clinical models and quantitative dipyridamole-thallium imaging to predict cardiac morbidity and death after vascular reconstruction.

Patients with peripheral vascular disease have a high prevalence of coronary artery disease and are at increased risk for cardiac morbidity and death after vascular reconstruction. The present study was undertaken to assess the value of 18 clinical parameters, of 7 clinical scoring systems, and of quantitative dipyridamole-thallium imaging for predicting the occurrence of postoperative myocardial infarction or cardiac death. Vascular surgery was performed in 125 patients. Thirteen postoperative cardiac events occurred, including 10 cardiac deaths and 3 nonfatal infarctions. Clinical parameters were not useful in predicting postoperative outcome. All 63 patients with normal scan results or fixed perfusion defects underwent surgery uneventfully, whereas 21% (13/62) of patients with reversible defects had a postoperative cardiac complication. By use of quantitative scintigraphic indexes we found that patients with reversible defects could be stratified into intermediate and high-risk subgroups with postoperative event rates of 5% (2/47) and 85% (11/13), respectively, despite intensive postoperative monitoring and antianginal medication. Thus in patients unable to complete a standard exercise stress test, postoperative outcome cannot be predicted clinically, whereas dipyridamole-thallium imaging successfully identified all patients who had a postoperative cardiac event. By use of quantification we found that patients with reversible defects can be stratified into an intermediate risk subgroup that can undergo surgery with minimal complication rate and a high-risk subgroup that requires coronary angiography.

Canada↗
PubMed1992

The impact of selective use of dipyridamole-thallium scans and surgical factors on the current morbidity of aortic surgery.

Preoperative cardiac testing in patients undergoing vascular surgery remains controversial. We have advocated selective use of dipyridamole-thallium scans based on clinical markers of coronary artery disease before aortic surgery. The present study assessed both the efficacy of this policy and the role of surgical factors in the current morbidity of aortic reconstruction. Two hundred two elective aortic reconstructions (151 abdominal aortic aneurysms, 51 aortoiliac occlusive disease) performed in the period from January 1989 to June 1990 were reviewed. Preoperative dipyridamole-thallium scanning was performed in 29% of all patients, prompting coronary angiograms in 11% and coronary artery bypass grafting/percutaneous transluminal coronary angioplasty in 9% of patients before aortic reconstruction. The overall operative mortality rate was 2%, with one cardiac-related death. Major cardiac (nonfatal myocardial infarction, unstable angina) and pulmonary complications occurred in an additional 4% and 6%, respectively, of patients. Coronary artery disease clinical markers and surgical factors were analyzed with stepwise logistic regression for the prediction of operative mortality rates and major cardiopulmonary complications. Variables retaining significance in predicting postoperative death or cardiopulmonary complications included prolonged (more than 5-hour) operative time (p less than 0.004), operation for aortoiliac occlusive disease (p less than 0.010), and a history of ventricular ectopy (p less than 0.002). Prolonged operative time (p less than 0.006) and the detection of intraoperative myocardial ischemia (p less than 0.030) were predictive of major cardiac complications after univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

A negative thallium (+/- dipyridamole) stress test excludes significant obstructive epicardial coronary artery disease in hypertensive patients.

The operating characteristics of thallium stress testing for detection of significant epicardial coronary artery disease (CAD) in hypertensive subjects with chest pain or electrocardiographic (ECG) ischemia have not been previously defined. This becomes important because of the high prevalence of both hypertensive heart disease and CAD. Ninety-two hypertensives with a history of typical or atypical chest pain or ECG myocardial ischemia underwent coronary arteriography, 2D-guided echocardiography, and thallium-201 stress testing, combined with intravenous dipyridamole if the rate-pressure product was less than 20,000. Patients with myocardial infarction, prior revascularization procedure, valvular heart disease, and chronic ethanol abuse were excluded. The mean age was 54.8 +/- 9.9 years with 55% blacks and 46% women. Eighteen patients (19.6%) had significant (greater than or equal to 50% luminal diameter narrowing) epicardial CAD at catheterization, of whom 17 had positive thallium scans. Overall, there were 17 true positives, 47 true negatives, 27 false positives, and one false negative resulting in 94.4 +/- 5.4% sensitivity (95% confidence limits [95% CL] 71 to 100%), 63.5 +/- 5.6% specificity (95% CL 51 to 74%), 38.6 +/- 7.3% positive predictive value (95% CL 25 to 54%), 97.9 +/- 2.1% negative predictive value (95% CL 88 to 100%), and 69.6 +/- 4.8% overall accuracy (95% CL 59 to 79%). For hypertensive patients with chest pain or ECG myocardial ischemia, the high sensitivity and negative predictive value and low false negative rate support the role of thallium stress testing +/- dipyridamole as an exclusion test for significant CAD.

Adult↗
PubMed1979

Effects of nitroglycerin and dipyridamole on acute myocardial infarction: a thermographic study in the dog.

The effects on an acute myocardial infarction of equipotent hypotensive doses of nitroglycerin and dipyridamole were studied using the thermographic technique in open-chest dogs. Nitroglycerin did not reduce the cool ischaemic area in any of the nine dogs studied. In six of the dogs, in which the ischaemic region could be properly measured, the cool area slightly grew in size. Dipyridamole reduced the size of the ischaemic area in all the 20 dogs used. In the 19 in which the size could be adequately digitalised, the decrease in infarction size was statistically significant.

Acute Disease↗
PubMed1983

Dipyridamole-induced capillary endothelial cell proliferation in the rat heart--a morphometric investigation.

20 male Wistar rats were randomly divided into two equal groups. Each experimental rat was injected with 4 mg . kg-1 dipyridamole ip twice daily for 4 weeks, the control rats received sham injections of an equal volume of saline. The rats were fixed by retrograde vascular perfusion. Left ventricular papillary muscles were sampled for light and electron microscopic morphometry. By means of a combination of serial section reconstruction and morphometry we could demonstrate that the number of capillary endothelial cell nuclei per tissue volume had increased by 37% (P less than 0.01), whereas the average nuclear volume remained constant. All other morphometric parameters (volume densities of myocardial cells, capillaries, cellular and non-cellular interstitial tissue, and myocardial cell nuclei; surface area, diameter, and density of capillaries; volume densities of myofibrils, mitochondria, and sarcoplasmic matrix; surface areas of the inner and outer mitochondrial membranes; dimensions of average mitochondrial section profiles) were unchanged. We conclude that chronic dipyridamole application induces proliferation of capillary endothelial cells in the rat myocardium, possibly by an increase of myocardial blood flow.

Animals↗
PubMed1993

Dipyridamole echocardiography evaluation of acute inferior myocardial infarction with concomitant anterior ST segment depression.

The significance of anterior ST segment depression in inferior acute myocardial infarction (AMI) remains controversial. The aim of this study was to relate precordial ST segment depression to the topography of residual myocardial ischaemia, with myocardial mapping of the asynergic area and coronary anatomy. Twenty-five patients with first inferior AMI (15 patients with anterior ST segment depression: group A and 10 patients without anterior ST segment shift: group B), all underwent: (1) electrocardiographic evaluation on admission to the Coronary Care Unit and at 24 h intervals thereafter; (2) 2D-echocardiographic study within 3 h of CCU admission; (3) dipyridamole echocardiographic test (DET) (doses of dipyridamole up to 0.84 mg.kg-1 i.v. over 10 min) 4 days after AMI; (4) coronary arteriography within 14 days from AMI. To assess regional left ventricular wall motion, a 16 segment model was used and a wall motion score index (WMSI) was derived. The results of DET were correlated to the anatomy of the infarct-related vessel. Compared to group B, group A patients showed a significantly greater maximal ST segment elevation in inferior limb leads (lead III: 3.9 +/- 1.9 mm vs 2.2 +/- 1.1 mm, P < 0.05; aVF: 3.5 +/- 1.3 mm vs 1.7 +/- 0.8 mm, P < 0.001). Group A patients showed greater WMSI (1.35 +/- 0.22 vs 1.17 +/- 0.12, P < 0.05), with more frequent postero-lateral wall involvement (72% vs 20%, P < 0.05). No patient of either group showed asynergy of the anterior, anterolateral or anteroseptal segments. No differences in the distribution of coronary artery disease were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Early post-infarction angina: usefulness of dipyridamole-echocardiography test.

Thirty-nine patients with early post-infarction angina (all with significant, angiographically assessed coronary artery disease and a baseline asynergy on 2-D echo), performed a dipyridamole-echocardiography test (DET: 2-D echo monitoring with dipyridamole infusion, 0.14 mg kg-1 min-1 for 4 min). Twenty-nine patients had a positive DET (sensitivity = 74%). Two mechanical patterns of DET-positivity could be identified: a worsening of the asynergy in that same region showing a baseline asynergy (11 patients); a 'de novo' asynergy in a region remote from the one showing a baseline asynergy (18 patients); The prevalence of single-vessel disease was significantly higher in patients with type 1 positivity pattern (6 single-, three double- and two triple-vessel disease), while patients with type 2 positivity always showed a multivessel coronary involvement (8 double-, 10 triple-vessel disease). In 4 of the 10 patients with 3-vessel disease and type 2 asynergy, such asynergy developed in a territory different from the one supplied by the more stenotic non-infarct-related vessel. In conclusion, DET represents a safe and feasible tool effectively to localize ischaemia, relative to the infarcted region, and to evaluate the haemodynamic significance of coronary lesions in patients with post-infarction angina.

Adult↗
PubMed1994

Dipyridamole echocardiographic test performed 3 days after an acute myocardial infarction: feasibility, tolerability, safety and in-hospital prognostic value.

In recent years, increasing evidence has pointed to the potential of dipyridamole stress echocardiography as a fast, effective, inexpensive method of risk stratification after an acute myocardial infarction. A very early stratification by this test could improve the patient's management and reduce the duration of in-hospital stay, and, thus, the costs. Two-hundred and fifty-one consecutive patients (208 male, age 58 +/- 11) with a two-dimensional echocardiogram of good technical quality underwent a dipyridamole echocardiographic test (DET) 70 +/- 6 h after an acute myocardial infarction. Criterion for positivity was the identification of a transient regional asynergy that was absent or of a lower degree in the baseline examination. Positivity was defined as 'at low-dose' or 'at high-dose' if the asynergy was detected before or after the 8th min of a drug infusion. All tests were performed without any major side effects. DET was positive in 149 (59%) and negative in 102 (41%) patients. During the hospital stay, cardiac events (death, reinfarction, angina) occurred in 52/251 patients: in 49/149 with a positive and in 3/102 with a negative test (sensitivity 94%, negative predictive value 97%, P < 0.00001). Severe events (death and reinfarction) occurred in 14/251: in 12/149 with a positive DET and in 2/102 with a negative DET (sensitivity 86%; negative predictive value: 98%; P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Effect of various antithrombotic regimens (aspirin, aspirin plus dipyridamole, anticoagulants) on the functional status of patients and grafts one year after coronary artery bypass grafting.

From 1987 until 1991 a large prospective randomized multicentre study was performed in The Netherlands, Germany and Switzerland entitled CABADAS (Prevention of Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole, and Acenocoumarol/Phenprocoumon Study). The aim of CABADAS was to evaluate the relative efficacy of (1) aspirin, (2) aspirin plus dipyridamole, and (3) oral anticoagulants in the prevention of vein graft occlusion during the first year after aortocoronary bypass surgery. No significant difference was observed in the incidence of graft occlusion among the three treatment groups. In a subgroup of 127 CABADAS patients, studied in the Academic Medical Centre in Amsterdam, the relationship between treatment and clinical status (i.e. symptoms of angina pectoris and exercise capacity) was assessed, and the relationship between treatment and functional status of the vein grafts was determined by means of thallium-201 exercise scintigraphy. There were no differences in symptoms among the three treatment groups in the 127 patients studied. There were no significant differences either among the treatment groups, as regards exercise capacity and the number or intensity of perfusion defects, in the 81 patients who underwent thallium-201 exercise scintigraphy. The three antithrombotic treatment regimens had a similar effect on the clinical status of patients and on the functional status of venous bypass grafts one year after coronary bypass surgery. This finding underscores the CABADAS results in that aspirin may be the preferred treatment option in patients following venous bypass surgery.

Acenocoumarol↗
PubMed1995

Dobutamine stress echocardiography compared with dipyridamole thallium-201 single-photon emission computed tomography in detecting coronary artery disease.

To compare the diagnostic value of dobutamine stress echocardiography with dipyridamole thallium-201 single-photon emission computed tomography (SPECT) in detecting coronary artery disease (CAD), we performed both tests on 54 patients who also underwent coronary arteriography. Dobutamine was infused at an incremental regimen of 5, 10, 20, 30 and 40 micrograms.kg-1.min-1. Dipyridamole was infused at a rate of 0.14 mg.kg-1.min-1 over 4 min. Dobutamine stress echocardiography detected 40 (93%) and SPECT 42 (98%, P = ns) of the 43 patients with significant CAD, defined as > or = 50% diameter stenosis. The specificity was 73% (8 of 11) for both tests. The sensitivity for detecting individual coronary artery stenosis with dobutamine stress echocardiography was 81% (30 of 37) for the left anterior descending artery, 75% (24 of 32) for the right coronary artery, and 61% (17 of 28) for the left circumflex artery. For SPECT it was 89%, 97% (P < 0.05 vs dobutamine stress echocardiography) and 75%, respectively. Among the 97 stenotic coronary arteries, 17 had mild to moderate stenosis (50%-69% diameter stenosis) and 80 had severe stenosis (> or = 70% diameter stenosis). With dobutamine stress echocardiography, 53% of the arteries with mild to moderate stenosis were identified vs 78% of those with severe stenosis (P < 0.05). With SPECT, the sensitivity was 82% (14 of 17) in mild to moderate stenosis and 89% (71 of 80) in severe stenosis (P = ns). No major side effects occurred during either test. Thus, both dobutamine stress and SPECT are highly sensitive for detection and localization of CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Plasma concentrations of platelet-specific proteins and serum thromboxane B2 production in response to treatment with dipyridamole. A pilot study of 27 post-myocardial infarction patients.

In the present study 27 post-myocardial infarction patients were treated with Persantin capsules (Depot-Kapseln, sustained release form), containing 200 mg dipyridamole, b.i.d. over a period of 3 weeks. Baseline levels for plasma beta-thromboglobulin (BTG), platelet factor 4 (PF4), and serum thromboxane B2 (TXB2) were obtained on day 0 and subsequently on days 1, 3, 5, 7, 14 and 21. The baseline levels for plasma BTG and PF4 as well as for serum TXB2 significantly exceeded those for a control group consisting of healthy subjects. The plasma values for BTG and PF4 remained unchanged during the whole study period. During the first week of study the levels for serum X TXB2 were unchanged; however, on days 14 and 21 the means for TXB2 dropped significantly. There is experimental work to suggest that dipyridamole may exert an inhibitory effect on platelet thromboxane biosynthesis. The present results support this concept.

Adult↗
PubMed1988

Efficacy of intravenous dipyridamole with exercise in thallium-201 myocardial perfusion scintigraphy.

To assess the feasibility and the value of thallium-201 myocardial perfusion imaging with intravenous dipyridamole in combination with low-level exercise, 81 patients with suspected or proven coronary artery disease were studied. All patients underwent coronary arteriography. Significant coronary artery disease (stenoses greater than or equal to 50%) was present in 59 patients (73%); multivessel disease (double- and triple-vessel disease) was observed in 33 patients (42%). The overall sensitivity and specificity of the test were 78% and 86%, respectively. Sensitivity and specificity for detection of multivessel disease were 70% and 92%, respectively. The sensitivity for detecting coronary artery disease in the RCA, LAD, and LCX was 74%, 82% and 48%, respectively, and the specificity was 85%, 88% and 88%, respectively. With the combined procedure no serious side effects were observed. Mild side effects like headache, vertigo and nausea were seen in 12 patients (15%). Twenty volunteers with a less than or equal to 1% likelihood of significant coronary artery disease were examined in the same manner to determine the maximal specificity of the procedure (100%). Thus, the combination of two different stress procedures (exercise testing and dipyridamole infusion) can be performed safely without serious side effects. The presence, location and extent of significant coronary artery disease can be assessed to a similar degree as with conventional exercise thallium-201 scintigraphy, which has major implications for the detection of coronary artery disease in patients who are unable to perform maximal exercise.

Adult↗
PubMed1988

Dipyridamole-thallium 201 scintigraphy in the early post-infarction period. (Safety and accuracy in predicting the extent of coronary disease and future recurrence of angina in patients suffering from their first myocardial infarction).

To evaluate the safety and usefulness of myocardial thallium-201 scintigraphy after intravenous dipyridamole during the early post-infarction period, 35 patients under 60 years of age and with recent first transmural uncomplicated myocardial infarction (27 inferior, 8 anterior) were examined between the 5th and 13th day of hospitalization. Although four patients experienced angina and transient ischemic ST depression during the test, there were no serious complications. Patients were followed for a mean period of 11.4 +/- 6.3 months after hospital discharge. None of the patients experienced recurrent infarction and there were no cardiac deaths. In 11 patients there were reversible perfusion defects in areas different from those of myocardial infarction. Of these patients, seven (one with infarct vessel stenosis only and six with multivessel coronary disease) developed angina during the follow-up: five underwent coronary surgery because of severe angina refractory to full medical therapy. Out of the 24 patients without reversible perfusion defects, only two (with multivessel coronary disease) showed typical angina symptoms. The presence of redistribution on thallium scans was significantly more frequent in patients who developed a recurrence of angina over a period of 11.4 +/- 6.3 months of follow-up (P less than 0.0005). Thus dipyridamole-thallium 201 scintigraphy is a safe, non-invasive stress test which may be used early following uncomplicated myocardial infarction in order to identify patients at risk for the recurrence of angina.

Adult↗
PubMed2000

Phase II evaluation of continuous-infusion 5-fluorouracil, leucovorin, mitomycin-C, and oral dipyridamole in advanced measurable pancreatic cancer: a North Central Cancer Treatment Group Trial.

At present there remains a need for more effective systemic therapy in advanced pancreatic cancer. Some studies have suggested that infusional chemotherapy schedules and biomodulation of 5-fluorouracil (5-FU) may improve the therapeutic outcome in advanced colon cancer. One such regimen that uses continuous infusion 5-FU, weekly leucovorin, daily dipyridamole, and intermittent mitomycin-C has activity in both colon and unresectable pancreatic carcinoma. The intent of this trial was to test the effectiveness of this four-drug regimen in advanced pancreatic cancer. Patients received 5-FU 200 mg/m2 daily by continuous infusion, leucovorin 30 mg/m2 IV weekly, mitomycin-C 10 mg/m2 day 1, and dipyridamole 75 mg orally four times daily for 5 weeks. After a 1-week break, treatment cycles were repeated every 6 weeks. Eligibility included biopsy-proven advanced measurable pancreatic cancer, Eastern Cooperative Oncology Group performance status 0 and 2, and no prior systemic chemotherapy. Of 46 evaluable patients, 9 partial responses and 1 complete tumor response were seen, for an overall response rate of 22% (95% confidence interval 11-36%). The median survival in the group of 50 patients registered to this trial was 4.6 months, with a range of 0.33 to 40.2 months. Toxicity was manageable, with the most common toxicities (> or =grade III National Cancer Institute Common Toxicity Criteria) being anorexia (13%), stomatitis (17%), and hand-foot syndrome (13%). Of note, little severe hematologic toxicity and no significant headaches were reported. Although some patients did respond, the therapeutic results are not encouraging enough to take this regimen to phase III testing.

Adult↗
PubMed1995

Preoperative dipyridamole thallium imaging and ambulatory electrocardiographic monitoring as a predictor of perioperative cardiac events and long-term outcome.

BACKGROUND: Dipyridamole thallium imaging (DTI) and ambulatory electrocardiography (AEGC) have been advocated as means to stratify risk before vascular surgery. The purpose of this study was to compare the predictive value of both tests in noncardiac surgery patients for perioperative cardiac morbidity and long-term mortality. METHODS: One hundred eighty patients were referred to the nuclear cardiology laboratory for DTI before noncardiac surgery. In patients with normal electrocardiograms and who consented, an ambulatory electrocardiogram was recorded for 24 h. DTI results were classified as negative, positive, or strongly positive (included in positive). Patients were assessed for a minimum of 12 months, and Kaplan-Meier cardiovascular survival curves were constructed with a log-rank statistic of equality with P < 0.05 significant. RESULTS: One hundred nine patients had both tests and then underwent surgery, sustaining 10 perioperative cardiac events (cardiac death, myocardial infarction, or symptomatic ischemia). The positive predictive values for DTI (18%) and AECG (25%) were similar, as were the likelihood ratios for positive tests (DTI = 2.1, AECG = 3.3). The likelihood ratios of a negative test were also similar (DTI = 0.45, AECG = 0.48). A strongly positive thallium defect had a somewhat greater likelihood ratio (3.5) for in-hospital events and was the only test result associated with a significantly worse long-term cardiac survival. CONCLUSIONS: AECG and DTI demonstrated a similar, although lower than initially reported, ability to stratify risk and predict short-term outcome. Only quantitative dipyridamole thallium also had predictive value for long-term prognosis.

Aged↗