DOPPLER-ECHOCARDIOGRAPHY WITH DIPYRIDAMOL E AFTER THROMBOLYZED MYOCARDIAL-INFARCTION - COMPARISON WITH CORONARY ARTERIOGRAPHY FINDINGS

The reliability and safety of Doppler echocardiography with dipyridamo le (0.84 mg/kg in 10 min) were evaluated in 63 patients an average of 7 days after a thrombolysed early lateral infarct and 24 hours before follow-up coronary arteriography. The aims of the test were the detect ion of tight stenoses (diameter reduced by more than 75 %) affecting t he artery responsible for the infarct as well as the other coronary ve ssels, using the vasodilator action of dipyridamole. The echocardiogra phic manifestation of induced coronary steal consisted of transitory a synergism in the territory of the artery involved. Clinical tolerabili ty of the test was good. The brief onset of anginal pain was neverthel ess seen in 6 patients. Analysis of the zone corresponding to the necr osed area was possible in only 43 cases. Sensitivity of the test for d etection of a post-infarction residual stenosis was 64 % (39-89) and s pecificity 90 % (79-100). Study of other territories was possible in 5 9 cases. Sensitivity of the test for the diagnosis of multiple vessel disease was 70 % (42-98) and specificity 94 % (88-1 00). In the popula tion as a whole, Doppler study of variations in anterograde mitral flo w revealed a sensitivity of 40 % (27-53) and specificity of 87 % (78-9 6). Variations in sub-aortic flow were analysed only in the final 27 p atients, with a sensitivity and specificity of 100 %. The specificity of dipyridamole echocardiography after infarction is good, both for th e detection of residual stenosis and that of multiple vessel disease, the chief limiting factor being the impossibility of analysis of the i nfarcted region in the presence of initial akinesis. Only the analysis of variations in sub-aortic flow by Doppler appears to offer good sen sitivity.