Sensitivity of dipyridamole stress echocardiography (DIP-E) has been reported to be less than ideal in particular subsets of patients such as those with less severe extent of coronary artery disease (CAD). To verify if sensitivity could be improved, ATRO (1 mg in 2 minutes) was added at the end of a negative high-dose (0.84 mg/kg over 10 minutes) DIP-E in 61 consecutive patients (58 men, aged 53±7 years) evaluated for chest pain (33%) or for detection of residual ischemia after acute myocardial infarction (AMI) or previous MI (67%). DIP-E was positive in 28/61 (46%) and negative in 33/61 (54%) patients. Additional echo positivity was obtained in 18/33 (54%) patients after ATRO. Coronary arteriography was normal in 6 patients (10%); 1-vessel CAD was diagnosed in 28 (46%), 2-vessel CAD in 16 (26%) and 3-vessel CAD in 11 (18%) cases. The sensitivity for CAD diagnosis was 49% (27/55) for DIP-E and 84% (46/55) for DIP-E + ATRO (p<0.001). Specificity was 83% and 80%, respectively. Diagnostic accuracy increased from 52% to 83% (p<0.001). The better diagnostic accuracy of DIP-E was mainly related to the significant increase in sensitivity of the combined test in patients with 1-vessel CAD (from 46% to 75%) (p<0.005). At quantitative coronary evaluation, compared to patients with positive DIP-E + ATRO or negative DIP-E + ATRO test, patients with positive DIP-E had a higher mean % diameter stenosis: 80±13% vs 72±24% and 65±36%, respectively. Peak heart rate was significantly higher after the addition of ATRO vs basal and DIP alone in patients with a positive DIP-E + ATRO test. The addition of ATRO to DIP increases diagnostic accuracy of DIP-E particularly in patients with less severe extent of CAD; ATRO may be considered as a useful routine procedure for increasing diagnostic value of DIP-E test.
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Picano E, Lattanzi F, Masini M, Distante A, L'Abbate A. High dose dipyridamole echocardiography test in effort angina pectoris. J Am Coll Cardiol 1986; 8: 848–54.
Picano E. Dipyridamole echocardiography test: historical background and physiologic basis. Eur Heart J 1989; 10: 365–76.
Picano E, Lattanzi F. Dipyridamole echocardiography. A new diagnostic window on coronary artery disease. Circulation (Suppl) 1991;83: III 19–26.
Salustri A, Fioretti PM, McNeill AJ, Pozzoli MMA, Roelandt JRTC. Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischemia: a comparison between dobutamine and dipyridamole. Eur Heart J 1992; 13: 1356–62.
Bolognese L, Sarasso G, Aralda D, Bongo AS, Rossi L, Rossi P. High dose dipyridamole echocardiography early after uncomplicated acute myocardial infarction: correlation with exercise testing and coronary angiography. J Am Coll Cardiol 1989; 14: 357–63.
Mazeika P, Nihoyannopoulos P, Joshi J, Oakley CM. Uses and limitations of high dose dipyridamole stress echocardiography for evaluation of coronary artery disease. Br Heart J 1992; 67: 144–9.
Previtali M, Lanzarini L, Fetiveau R, Poli A, Ferrario M, Falcone C, Mussini A. Comparison of dobutamine stress echocardiography, dipyridamole stress echocardiography and exercise stress testing for diagnosis of coronary artery disease. Am J Cardiol 1993; 72: 865–70.
Kern MJ, Pearson AC, Labovitz A, Deligonul U, Vandormael M, Gupidati C. Effects of pharmacologic coronary hyperemia on echocardiographic left ventricular function in patients with single vessel coronary artery disease. J Am Coll Cardiol 1989; 13: 1042–51.
McNeill AJ, Fioretti PM, El-Said M. El-Said, Salustri A, Forster T, Roelandt JRCT. Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography. Am J Cardiol 1992; 70: 41–6.
Picano E, Pingitore A, Conti U, Kozakovà M, Boem A, Cabani E, Ciuti M, Distante A, L'Abbate A. Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dipyridamole echocardiography. Eur Heart J 1993; 14: 1216–22.
Previtali M, Lanzarini L, Ferrario M, Tortorici M, Mussini A, Montemartini C. Dobutamine versus dipyridamole echocardiography in coronary artery disease. Circulation (Suppl) 1991: 83: III 27–31.
Picano E, Marini C, Pirelli S, Maffei S, Bolognese L, Chiriatti G, Chiarella F, Orlandini A, Seveso G, Quarta Colosso M, Sclavo MG, Magaia O, Agati L, Previtali M, Lowenstein J, Torre F, Rosselli P, Ciuti M, Ostojic M, Gandolfo N, Margaria F, Giannuzzi P, Di Bello V, Lombardi M, Gigli G, Ferrara N, Santoro F, Lusa AM, Chiarandá G, Papagna D, Coletta C, Boccardi L, De Cristofaro M, Papi L, Landi P. Safety of intravenous high-dose dipyridamole echocardiography. Am J Cardiol 1992; 70: 252–56.
Mancini GBJ, Simon SB, McGillem MJ, LeFree MT, Friedman HZ, Vogel RA. Automated quantitative coronary arteriography: morphologic and physiologic validation in vivo of a rapid digital angiographic method. Circulation 1987; 75: 452–60.
Ardissino D, Barberis P, DeServi S, Merlini PA, Bramucci E, Falcone C, Specchia G. Abnormal coronary vasoconstriction as a predictor of restenosis after successful coronary angioplasty in patients with unstable angina pectoris. N Engl J Med 1991; 325: 1053–70.
Picano E. Stress echocardiography: from pathophysiological toy to a diagnostic tool. Point of view. Circulation 1992; 85: 1604–12.
Lattanzi F, Picano E, Bolognese L, Piccinino C, Sarasso G, Orlandini A, L'Abbate A. Inhibition of dipyridamole-induced ischemia by antianginal therapy in humans. Correlation with exercise electrocardiography. Circulation 1991;83: 1256–62.
Picano E, Lattanzi F, Masini M, Distante A, L'Abbate A. Usefulness of the dipyridamole-exercise echocardiography test for diagnosis of coronary artery disease. Am J Cardiol 1988; 62: 67–70.
Picano E, Lattanzi F, Masini M, Distante A, L'Abbate A. Does the combination with handgrip increase the sensitivity of dipyridamole-echocardiography test? Clin Cardiol 1987; 10: 37–9.
Andrade MJ, Picano E, Pingitore A, Petix N, Mazzoni V, Landi P, Raciti M. Dipyridamole stress echocardiography in patients with severe left main coronary artery narrowing. Am J Cardiol 1994; 73: 450–5.
Gross GJ, Waltier DC. Coronary steal in four models of single or multiple vessel obstruction in dogs. Am J Cardiol 1981;48: 84–92.
Gould KL. Coronary artery stenosis. New York: Elsevier Science Publishing, 1991.
Picano E, Lattanzi F, Orlandini O, Marini C, L'Abbate A. Stress echocardiography and the human factor: the importance of being expert. J Am Coll Cardiol 1991; 17: 666–9.
Iliceto S, Galiuto L, Marangelli V, Rizzon P. Clinical use of stress echocardiography: factors affecting diagnostic accuracy. Eur Heart J 1994; 15: 672–80.
Poldermans D, Fioretti PM, Boersma E, Forster T, van Hurk H, Cornel JH, Amese MR, Roelandt JRTC. Safety of dobutamineatropine stress echocardiography in patients with suspected or proven coronary artery disease. Am J Cardiol 1994; 73: 456–9.
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Lanzarini, L., Fetiveau, R., Poli, A. et al. Results of dipyridamole plus atropine echo stress test for the diagnosis of coronary artery disease. Int J Cardiac Imag 11, 233–240 (1995). https://doi.org/10.1007/BF01145191
- stress echocardiography