TY - JOUR
T1 - Usefulness of oral dipyridamole suspension for stress thallium imaging without exercise in the detection of coronary artery disease
AU - Homma, Shunichi
AU - Callahan, Ronald J.
AU - Ameer, Barbara
AU - McKusick, Kenneth A.
AU - Strauss, H. William
AU - Okada, Robert D.
AU - Boucher, Charles A.
N1 - Funding Information:
From the Cardiac Unit and Division of Nuclear Medicine, Massachusetts General Hospital, Boston, Massachusetts. This study was supported in part by Grants HL 32953, HL 07416 and HL 07535 from the U.S. Public Health Service, National Heart, Lung, and Blood Institute, Bethesda, Maryland. Manuscript received May 28, 1985; revised manuscript received July 22, 1985, accepted July 30,1985.
PY - 1986/5/3
Y1 - 1986/5/3
N2 - Stress thallium imaging with intravenous dipyridamole permits assessment of coronary artery disease (CAD) without the need for exercise. However, intravenous dipyridamole is available in the United States only on an experimental basis. To study the use of oral dipyridamole as a clinically available alternative to intravenous dipyridamole for this purpose, 100 patients underwent thallium imaging with oral dipyridamole. Each patient received 300 mg of pulverized tablets in a 30-ml suspension. Maximal increase in mean heart rate and decrease in mean blood pressure occurred 30 minutes after ingestion. At 45 minutes, 2 mCi of thallium was given intravenously and serial imaging was begun within 7 minutes. The serum dipyridamole level (mean ± standard deviation) 45 minutes after 300 mg was administered orally (3.7 ± 2.2 μg/ml) was similar to that 5 minutes after 0.56 mg/kg was given intravenously (4.6 ± 1.3 μg/ml). Fifty-five patients had some adverse effects between 15 and 75 minutes after oral ingestion, including nausea, headache, dizziness, chest pain (25 patients) and electrocardiographic changes (14 patients). Intravenous aminophylline was used to resolve these adverse effects in 21 patients. There were no severe arrhythmias, myocardial infarctions or deaths. Of the 43 patients with angiographically documented CAD, 39 had an initial perfusion defect that redistributed on the delayed images. When the results in patients who had undergone catheterization were analyzed by individual segment, the presence of thallium redistribution was associated with normal or hypokinetic contrast left ventriculographic wall motion of that segment, whereas the presence of a persistent defect was associated with akinesia or dyskinesia (Fisher's standardized Z = 9.14). In conclusion, stress thallium imaging without exercise is feasible with a clinically available form of dipyridamole-the oral suspension. It is safe and may be used for evaluation of CAD to unmask regions of hypoperfused viable myocardium.
AB - Stress thallium imaging with intravenous dipyridamole permits assessment of coronary artery disease (CAD) without the need for exercise. However, intravenous dipyridamole is available in the United States only on an experimental basis. To study the use of oral dipyridamole as a clinically available alternative to intravenous dipyridamole for this purpose, 100 patients underwent thallium imaging with oral dipyridamole. Each patient received 300 mg of pulverized tablets in a 30-ml suspension. Maximal increase in mean heart rate and decrease in mean blood pressure occurred 30 minutes after ingestion. At 45 minutes, 2 mCi of thallium was given intravenously and serial imaging was begun within 7 minutes. The serum dipyridamole level (mean ± standard deviation) 45 minutes after 300 mg was administered orally (3.7 ± 2.2 μg/ml) was similar to that 5 minutes after 0.56 mg/kg was given intravenously (4.6 ± 1.3 μg/ml). Fifty-five patients had some adverse effects between 15 and 75 minutes after oral ingestion, including nausea, headache, dizziness, chest pain (25 patients) and electrocardiographic changes (14 patients). Intravenous aminophylline was used to resolve these adverse effects in 21 patients. There were no severe arrhythmias, myocardial infarctions or deaths. Of the 43 patients with angiographically documented CAD, 39 had an initial perfusion defect that redistributed on the delayed images. When the results in patients who had undergone catheterization were analyzed by individual segment, the presence of thallium redistribution was associated with normal or hypokinetic contrast left ventriculographic wall motion of that segment, whereas the presence of a persistent defect was associated with akinesia or dyskinesia (Fisher's standardized Z = 9.14). In conclusion, stress thallium imaging without exercise is feasible with a clinically available form of dipyridamole-the oral suspension. It is safe and may be used for evaluation of CAD to unmask regions of hypoperfused viable myocardium.
UR - http://www.scopus.com/inward/record.url?scp=0022531772&partnerID=8YFLogxK
U2 - 10.1016/0002-9149(86)90824-6
DO - 10.1016/0002-9149(86)90824-6
M3 - Article
C2 - 3953432
AN - SCOPUS:0022531772
SN - 0002-9149
VL - 57
SP - 503
EP - 508
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 8
ER -