HIGH-DOSE DIPYRIDAMOLE AS A PHARMACOLOGICAL STRESS TEST DURING CARDIAC-CATHETERIZATION IN PATIENTS WITH CORONARY-ARTERY DISEASE

Aim-To validate dipyridamole pharmacological stress test during cardia c catheterisation, allowing both functional and morphological estimati on of stenosis severity. Methods-The study encompassed 74 patients: 62 patients with significant coronary artery disease (age 61 (SD 8) year s; seven women, 55 men) and 12 controls. Regional wall motion, left ve ntricular ejection fraction and end diastolic pressure were analysed i n the resting state and after high dose intravenous dipyridamole. Pati ents were subdivided into four groups: group I (n = 32, 43%) had stopp ed all anti-ischaemic treatment for > 24 h, group II (n = 14, 19%) was under treatment, group III (n = 16, 22%) had significant coronary art ery disease only in regions with regional wall motion abnormalities at rest, and group IV consisted of 12 control patients (16%) with no sig nificant coronary artery disease (age 62 (8) years, three women, nine men). Results-The sensitivity of dipyridamole testing in patients with coronary artery disease was poor. The best sensitivity was obtained w ith regional wall motion analysis (26/62 = 42%) and with global left v entricular ejection fraction (25/62 = 40%). Specificity was 100% for r egional wall motion and 100% for ejection fraction. Calculated positiv e and negative predictive values for regional wall motion were 100% an d 63%, respectively. Conclusions-Although safe, handy, and inexpensive , dipyridamole is not an adequate pharmacological stress test during c ardiac catheterisation because of its low sensitivity.