Non-invasive prediction of angiographic progression of coronary artery disease by dipyridamole-stress echocardiography

Background Coronary angiography is the currently accepted standard means fo r assessing progression of coronary artery disease. A dipyridamole-echocard iography test (DET) might provide an alternative non-invasive functional im aging method for this purpose. Objective To assess whether variations in results of serial DET match varia tions in angiographic assessments of coronary artery disease. Methods From the Pisa Institute of Clinical Physiology stress-echocardiogra phy data bank (1983-1998), we selected 60 patients satisfying the inclusion criteria of coronary angiography and DET having each been performed and in terpreted twice independently and within 1 week. The second angiographic an d stress-echocardiographic assessment was performed 45 +/- 31 months after the initial one. Angiographic progressors were defined a priori as patients with any progression of stenosis to occlusion and those with any stenosis > 30% with > 20% progression of stenosis measured by visual and quantitativ e coronary angiography. Stress-echocardiography progressors were defined as those patients who had previously had a negative test of a test having a p ositive result and those patients who had positive results of tests both in initial testing and in a second session of testing with the latter having a peak wall-motion-score index > 0.12 (on a scale of 1, normal to 4, dyskin etic in a 16-segment model) larger than the former. Results Of the 60 patients, 44 were angiographic 'progressors' and 16 were 'non progressors'. Stress-echocardiographic responses were concordant with angiographic identification for 39 of 44 progressors and 15 of 16 non-progr essors, with an overall concordance of 90%. Conclusions Measurement of dipyridamole-stress-echocardiographic response a llows one to separate angiographic progressors and non-progressors efficien tly, simply by taking into account the presence, extent and severity of str ess-induced abnormalities of wall motion. Coron Artery Dis 12:197-204 (C) 2 001 Lippincott Williams & Wilkins.