DOPPLER DETERMINED AORTIC ACCELERATION AFTER DIPYRIDAMOLE IN THE PREDICTION OF CORONARY-ARTERY DISEASE

Change in the acceleration of aortic blood flow with stress testing is reported to reflect the presence of myocardial ischaemia. We studied its clinical usefulness when compared with dipyridamole thallium scint igraphy in 101 patients, of whom 64 had coronary angiography. Maximum aortic acceleration increased after dipyridamole (P < 0.0001), althoug h no correlation existed between the aortic acceleration and evidence of thallium perfusion abnormalities. For the patients who had angiogra phy, the increase in aortic acceleration was similar for those with no significant coronary stenoses, single vessel or multi-vessel disease. Compared with coronary angiography, Doppler measurement of maximum ao rtic acceleration had a sensitivity of 92% and a specificity of 37% fo r the detection of coronary artery disease. When patients with previou s myocardial infarction or left ventricular dysfunction were excluded, there was still no relationship between the maximum aortic accelerati on and the presence of coronary artery disease. We conclude that chang es in the acceleration of aortic blood flow after dipyridamole stressi ng do not predict the presence or severity of coronary artery disease as measured from perfusion defects at thallium scintigraphy or by coro nary angiography. We have observed a wide variability of aortic maximu m acceleration in the evaluation of myocardial ischaemia, which we fee l introduces serious limitations to its use in routine clinical practi ce.