Author + information
- Received July 9, 1991
- Revision received September 26, 1991
- Accepted October 16, 1991
- Published online March 15, 1992.
- Luciano Agati, MDa,∗,
- Marco Renzi, MDa,
- Susanna Sciomer, MDa,
- Dario C. Vizza, MDa,
- Paolo Voci, MDa,
- Maria Penco, MDa,
- Francesco Fedele, MDb and
- Armando Dagianti, MD, FESCa
- ↵∗Address for reprints: Luciano Agati, MD, I Cattedra di Cardiologia, Policlinico Umberto 1, Università La Sapienza, 00161, Rome, Italy.
The value of transthoracic dipyridamole echocardiography has been extensively documented. However, in some patients, because of a poor acoustic window, the rest transthoracic examination is not always feasible and the transesophageal approach is more convenient.
Therefore, transesophageal echocardiography with high dose dipyridamole (up to 0.84 mg/kg body weight over 10 min) was performed in 32 patients in whom the transthoracic dipyridamole test either was not feasible (n = 29) or yielded ambiguous results (n = 3). The transesophageal echocardiographic test results were considered abnormal when new dipyridamole-induced regional wall motion abnormalities were observed. All 32 patients underwent coronary angiography; significant coronary artery disease was defined as ≥70% lumen diameter narrowing in at least one major vessel. All patients also performed a bicycle exercise test 1 day before transesophageal dipyridamole echocardiography.
Transesophageal stress studies were completed in all patients, with a maximal imaging time (in tests with a negative result) of 20 min. No side effects or intolerance to drug or transducer was observed. The left ventricle was always visualized in the four-chamber and transgastric short-axis views. High quality two-dimensional echocardiographic images were obtained in all patients both at rest and at peak dipyridamole infusion and were digitally analyzed in a quad-screen format.
Coronary angiography showed coronary artery obstruction in 24 patients: 6 had single-, 9 double- and 9 triple-vessel disease. The transesophageal dipyridamole test showed a specificity of 100% and an overall sensitivity of 92%. The sensitivity of this test for single-, double- and triple-vessel disease was 67%, 100% and 100%, respectively.
It is concluded that transesophageal dipyridamole echocardiographic testing is a useful detector of myocardial ischemia in patients with coronary artery disease, particularly in those in whom a transthoracic study either is not feasible or yields ambiguous results.
- Received July 9, 1991.
- Revision received September 26, 1991.
- Accepted October 16, 1991.