Author + information
- Received September 25, 1995
- Revision received November 21, 1995
- Accepted December 18, 1995
- Published online May 1, 1996.
- Eugenio Picano, MD,PhDa,∗,
- Miodrag Ostojic, MD,FACC∗,
- Albert Varga, MDa,
- Rosa Sicari, MDa,
- Ana Djordjevic-Dikic, MD∗,
- Ivana Nedeljkovic, MD∗ and
- Marco Torres, MDa
- ↵∗Address for correspondence: Dr. Eugenio Picano, Consiglio Nazionale della Ricerche, Institute of Clinical Physiology, Visa Paolo Savi, 8, 56123, Pisa, Italy.
Objectives. We sought to evaluate the effects of combined administration of infra-low dose dipyridamole and low dose dobutamine on assessment of myocardial viability.
Background. Low dose pharmacologic stress echocardiography with either dobutamine or dipyridamolc infusion has been proposed for the recognition of myocardial viability.
Methods. Thirty-four patients with rest wall motion dyssynergy by two-dimensional echocardiography and with angiographically proved coronary artery disease underwent in combination with two-dimensional echocardiographic monitoring: 1) low dose (5 to 10 μg/kg per min over 3 min) dobutamine infusion; 2) infra-low dose (0.28 mg/kg over 4 min) dipyridamole infusion; 3) combination of infra-low dose dipyridamole infusion immediately followed by low dose dobutamine infusion (combined dipyridamole-dobutamine).
Results. Follow-up rest echocardiography was available in 30 patients. After revascularization, 82 segments showed a contractile improvement of ≥1 grade, whereas 63 segments remained unchanged. The sensitivity of dobutamine, dipyridamole and combined dipyridamole-dobutamine for predicting recovery was 72% (95% confidence interval [CI] 60.9% to 81.3%), 67% (CI 55.8% to 77%) and 94% (CI 86.3% to 97.9%), respectively. The specificity of dipyridamole, dobutamine and combined dipyridamole-dobutamine was 95% (CI 86.7% to 99%), 92% (CI 82.4% to 97.3%) and 89% (CI 78.4% to 95.4%), respectively. The accuracy of the dobutamine, dipyridamole and combined dipyridamole-dobutamine test was 80%, 79% and 92%, respectively (combined dipyridamole-dobutamine vs. dobutamine, p < 0.05; combined dipyridamole-dobutamine vs. dipyridamole, p < 0.01).
Conclusions. Infra-low dose dipyridamole added to low dose dobutamine recruits an inotropic reserve in asynergic segments that were nonresponders after either dobutamine or dipyridamole alone and destined to recover after revascularization.
☆ This study was partially supported by Consaglio Nationale della Ricerche Grant 117347.
- Received September 25, 1995.
- Revision received November 21, 1995.
- Accepted December 18, 1995.