Dipyridamole-induced ST segment depression during thallium-201 imaging in patients with coronary artery disease

Angiographic and hemodynamic determinants

Charles Chambers, Kenneth A. Brown

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72 Citations (Scopus)

Abstract

To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34%) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral vessels, jeopardized collateral vessels, multivessel disease), hemodynamic changes (changes in heart rate, systolic pressure, diastolic pressure and rate-pressure product), thallium-201 results (perfusion defect, thallium-201 redistribution) and demographic data (age, gender, medications). Only the presence of good coronary collateral vessels (p < 0.02) and increases in rate-pressure product after dipyridamole infusion (p < 0.02) were significant multivariate predictors of dipyridamole-induced ST depression. Good collateral vessels were more common in the group with ST depression (11 [79%] of 14) than they were in the group without ST depression (6 [22%) of 27; p < 0.001). Rate-pressure product increased 2,835 ± 1,648 beats/ min · mm Hg in the group with ST depression compared with 1,179 ± 1,417 beats/min · mm Hg in patients without ST depression (p < 0.005). In conclusion, dipyridamole-induced ST segment depression in patients with coronary artery disease appears to be related to 1) the presence of good coronary collateral vessels, which may act by facilitating "coronary steal", and 2) increases in rate-pressure product, reflecting increased myocardial oxygen demand. These observations may explain the lack of prognostic value of dipyridamole-induced ST segment depression described in previous reports.

Original languageEnglish (US)
Pages (from-to)37-41
Number of pages5
JournalJournal of the American College of Cardiology
Volume12
Issue number1
DOIs
StatePublished - Jan 1 1988

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Dipyridamole
Thallium
Coronary Artery Disease
Hemodynamics
Pressure
Coronary Vessels
Blood Pressure
Myocardial Perfusion Imaging
Coronary Disease
Perfusion
Heart Rate
Logistic Models
Demography
Oxygen

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Dipyridamole-induced ST segment depression during thallium-201 imaging in patients with coronary artery disease: Angiographic and hemodynamic determinants",
abstract = "To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34{\%}) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral vessels, jeopardized collateral vessels, multivessel disease), hemodynamic changes (changes in heart rate, systolic pressure, diastolic pressure and rate-pressure product), thallium-201 results (perfusion defect, thallium-201 redistribution) and demographic data (age, gender, medications). Only the presence of good coronary collateral vessels (p < 0.02) and increases in rate-pressure product after dipyridamole infusion (p < 0.02) were significant multivariate predictors of dipyridamole-induced ST depression. Good collateral vessels were more common in the group with ST depression (11 [79{\%}] of 14) than they were in the group without ST depression (6 [22{\%}) of 27; p < 0.001). Rate-pressure product increased 2,835 ± 1,648 beats/ min · mm Hg in the group with ST depression compared with 1,179 ± 1,417 beats/min · mm Hg in patients without ST depression (p < 0.005). In conclusion, dipyridamole-induced ST segment depression in patients with coronary artery disease appears to be related to 1) the presence of good coronary collateral vessels, which may act by facilitating {"}coronary steal{"}, and 2) increases in rate-pressure product, reflecting increased myocardial oxygen demand. These observations may explain the lack of prognostic value of dipyridamole-induced ST segment depression described in previous reports.",
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N2 - To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34%) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral vessels, jeopardized collateral vessels, multivessel disease), hemodynamic changes (changes in heart rate, systolic pressure, diastolic pressure and rate-pressure product), thallium-201 results (perfusion defect, thallium-201 redistribution) and demographic data (age, gender, medications). Only the presence of good coronary collateral vessels (p < 0.02) and increases in rate-pressure product after dipyridamole infusion (p < 0.02) were significant multivariate predictors of dipyridamole-induced ST depression. Good collateral vessels were more common in the group with ST depression (11 [79%] of 14) than they were in the group without ST depression (6 [22%) of 27; p < 0.001). Rate-pressure product increased 2,835 ± 1,648 beats/ min · mm Hg in the group with ST depression compared with 1,179 ± 1,417 beats/min · mm Hg in patients without ST depression (p < 0.005). In conclusion, dipyridamole-induced ST segment depression in patients with coronary artery disease appears to be related to 1) the presence of good coronary collateral vessels, which may act by facilitating "coronary steal", and 2) increases in rate-pressure product, reflecting increased myocardial oxygen demand. These observations may explain the lack of prognostic value of dipyridamole-induced ST segment depression described in previous reports.

AB - To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34%) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral vessels, jeopardized collateral vessels, multivessel disease), hemodynamic changes (changes in heart rate, systolic pressure, diastolic pressure and rate-pressure product), thallium-201 results (perfusion defect, thallium-201 redistribution) and demographic data (age, gender, medications). Only the presence of good coronary collateral vessels (p < 0.02) and increases in rate-pressure product after dipyridamole infusion (p < 0.02) were significant multivariate predictors of dipyridamole-induced ST depression. Good collateral vessels were more common in the group with ST depression (11 [79%] of 14) than they were in the group without ST depression (6 [22%) of 27; p < 0.001). Rate-pressure product increased 2,835 ± 1,648 beats/ min · mm Hg in the group with ST depression compared with 1,179 ± 1,417 beats/min · mm Hg in patients without ST depression (p < 0.005). In conclusion, dipyridamole-induced ST segment depression in patients with coronary artery disease appears to be related to 1) the presence of good coronary collateral vessels, which may act by facilitating "coronary steal", and 2) increases in rate-pressure product, reflecting increased myocardial oxygen demand. These observations may explain the lack of prognostic value of dipyridamole-induced ST segment depression described in previous reports.

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