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Titolo:
Comparison and combination of dipyridamole and dobutamine during echocardiography with thallium scintigraphy to improve viability detection
Autore:
Sicari, R; Varga, A; Picano, E; Borges, AC; Gimelli, A; Marzullo, P;
Indirizzi:
CNR, Inst Clin Physiol, I-56100 Pisa, Italy CNR Pisa Italy I-56100CNR, Inst Clin Physiol, I-56100 Pisa, Italy
Titolo Testata:
AMERICAN JOURNAL OF CARDIOLOGY
fascicolo: 1, volume: 83, anno: 1999,
pagine: 6 - 10
SICI:
0002-9149(19990101)83:1<6:CACODA>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; LEFT-VENTRICULAR DYSFUNCTION; MYOCARDIAL VIABILITY; STRESS ECHOCARDIOGRAPHY; VIABLE MYOCARDIUM; HIBERNATING MYOCARDIUM; PREDICTING RECOVERY; TL-201 TOMOGRAPHY; REVASCULARIZATION; IDENTIFICATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
28
Recensione:
Indirizzi per estratti:
Indirizzo: Sicari, R CNR, Inst Clin Physiol, Via Savi 8, I-56100 Pisa, Italy CNR Via Savi 8 Pisa Italy I-56100 a Savi 8, I-56100 Pisa, Italy
Citazione:
R. Sicari et al., "Comparison and combination of dipyridamole and dobutamine during echocardiography with thallium scintigraphy to improve viability detection", AM J CARD, 83(1), 1999, pp. 6-10

Abstract

The aim of this study was to investigate the relation between radioisotopic and echocardiographic markers of myocardial viability and their correlation with functional recovery after coronary revascularization. Myocardial viability can be detected by techniques exploring various aspects of cell physiology: thallium-201 scintigraphy and dobutamine and dipyridamole echocardiography focus on cell membrane integrity, beta-l and adrenoceptor, and A2-adenosine receptor-mediated inotropic response, respectively. Fifty-seven patients (mean age 60 +/- 8 years) with previous myocardial infarction (>3 months), angiographically assessed coronary artery disease, and resting regional dysfunction underwent rest-redistribution 201-thallium scintigraphy and low-dose pharmacologic stress echo with dobutamine (up to 10 mu g/kg/min), very low dose regimen of dipyridamole (0.28 mg/kg over 4 minutes), and combined dipyridamole-dobutamine. Criteria for viability in a 13-segment model for both techniques were percent peak activity in redistribution images >55% for thallium-201 and a decrease in wall motion score >1 grade (1 [normal] to 4 [dyskinetic]) for stress echo. Thirty patients underwent coronary revascularization (bypass surgery in 8, angioplasty in 22) and were followedup at 4 weeks from intervention with a resting echocardiogram. The rate ofagreement between thallium-201 and stress echo was 63% for dipyridamole, 66% for dobutamine, and 74% for combined dipyridamole-dobutamine (p <0.05 vsdipyridamole and dobutamine). In the 30 patients who underwent revascularization, a regional resting dyssynergy was observed in 225 segments, assuming that postrevascularization functional recovery (which occurred in 126 segments) was the gold standard; combined dipyridamole-dobutamine showed a higher sensitivity (90% confidence interval [CI] 85% to 95%) than thallium-201, dobutamine, or dipyridamole (87%, CI 81% to 92%; 82%, CI 76% to 89%; and 82%, CI 76% to 89%, respectively). Specificity was lower for viability recognition with thallium-201 (61%, CI 51% to 71%) than with dobutamine (93%, CI 88% to 98%), dipyridamole (95%, CI 91% to 99%), and combined dipyridamole-dobutamine (92%; CI 87% to 97%). Combined adrenergic and adenosinergic stimulation recruits an inotropic reserve in a significant proportion of segments with preserved thallium uptake that were nonresponders after either dipyridamole or dobutamine. When functional recovery after successful revascularization is considered as the postoperative gold standard, thallium has a higher sensitivity than dipyridamole or dobutamine; this sensitivity gap isfilled with combined dipyridamole-dobutamine. The specificity of all formsof pharmacologic stress echo is better than thallium-201. (C)1999 by Excerpta Medica, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/04/20 alle ore 23:03:12