Skip to main content

Advertisement

SpringerLink
Log in

Dipyridamole-induced abnormal Tl-201 lung uptake in patients with normal myocardial perfusion: A marker of increased left ventricular filling pressures

  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The mechanism of dipyridamole-induced abnormal increased T1-201 lung uptake in patients without coronary artery disease is poorly understood. The purpose of this study was to evaluate the relation between dipyridamole-induced abnormal T1-201 lung uptake and left ventricular (LV) diastolic indexes using Doppler, color M-mode and Tissue Doppler modalities at rest, and at dipyridamole stress echocardiograpy (DSE) in patients with normal myocardial perfusion and LV function.

Methods and Results

18 consecutive patients (mean age 64 ± 7 years) with normal myocardial perfusion and increased lung T1-201 uptake on dipyridamole stress-redistribution single photon emission computed tomography (SPECT) were included in our study. These patients were compared with 18 age-matched control patients with normal perfusion and normal T1-201 lung uptake. All patients underwent DSE. A good correlation was found between the T-201 lung uptake, the peak early velocity of mitral inflow (E, r _ 0.57) and estimated pulmonary capillary wedge pressure (PCWP _ 1.24[E/Ea] _ 1.9, r _ 0.68). In patients with increased L/H ratio compared to control group, the E and the PCWP were significantly higher at baseline 81 ± 18 vs 68 ± 11 (cm/s) and 13 ± 3 vs 10.2 ± 2 (mmHg). An additional significant increase of E to 91 ± 23 (cm/s (P ± 0.001)) and PCWP to 14.8 ± 3 (P_ 0.005) after dipyridamole administration was seen; in contrast to a nonsignificant change observed in control group. For the detection of a dipyridamole induced PCWP >12 mmHg, a L/H ratio of ≥50% had a sensitivity of 72% and a specificity of 83%, resulting in a positive and a negative predictive value of 81% and 75%, respectively.

Conclusions

A dipyridamole-induced abnormal T1-201 lung uptake in patients with normal myocardial perfusion and systolic function is predictive of elevated filling pressures at rest and in response to dipyridamole administration, probably reflecting an intrinsic resting diastolic dysfunction and a further abnormal response to vasodilatation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boucher CA, Zir LM, Beller GA, et al. Increased lung uptake of thallium-201 during exercise myocardial imaging: clinical, hemodynamic and angiographic implications in patients with coronary artery disease. Am J Cardiol 1980;46:189–96.

    Article  PubMed  CAS  Google Scholar 

  2. Lio P, Kiess M, Okada RD, et al. Increased thallium lung uptake after exercise in isolated left anterior descending coronary artery disease. Am J Cardiol 1985;55:1969–73.

    Google Scholar 

  3. Brown KA, Makay R, Heller GV, et al. Hemodynamic determinants of thallium-201 lung uptake in patients during atrial pacing stress. Am Heart J 1986;111:103–7.

    Article  PubMed  CAS  Google Scholar 

  4. Nishimura S, Mahmarian J, Verani MS. Significance of increased lung thallium uptake during adenosine thallium-201 scintigraphy. J Nucl Med 1992;33:1600–7.

    PubMed  CAS  Google Scholar 

  5. Mahmood S, Buscombc JR, Ell PJ. The use of thallium-201 lung/heart ratio. Eur J Nucl Med 1992;19:807–14.

    Article  PubMed  CAS  Google Scholar 

  6. Ogilby JD, Abdulmassih S, Iskandrian A, et al. Effect of intravenous adenosine infusion on myocardial perfusion and function. Circulation 1992;86:887–95.

    PubMed  CAS  Google Scholar 

  7. NaguehSF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinoones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997;30:1527–33.

    Article  PubMed  CAS  Google Scholar 

  8. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging estimation of left ventricular filling pressure: a comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788–94.

    PubMed  CAS  Google Scholar 

  9. Kurata C, Tawaraha K, Taguchi T, et al. Lung thallium uptake during exercise emission computed tomography. Nucl Med 1991; 32:417–23.

    CAS  Google Scholar 

  10. Aksut SA, Malavarapu C, Russell J, Heo J, Iskandrian AS. Implication of increased thallium lung uptake during exercise single photon emission computed tomography imaging. Am Heart J 1995;130:367–73.

    Article  PubMed  CAS  Google Scholar 

  11. Kaul S, Finkelshtein DM, Homma S, et al. Superiority of quantitative exercise thallium-201 variables in determining long term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization. J Am Coll Cardiol 1988;12:25–34.

    Article  PubMed  CAS  Google Scholar 

  12. Gill JB, Ruddy TD, Newell JB, et al. Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 1987;317:1485–9.

    Google Scholar 

  13. O’Rourke RA. Lung uptake of thallium as a prognostic indicator. N Engl J Med 1987;317:1532–4.

    PubMed  CAS  Google Scholar 

  14. Brown KA. Prognostic value of thallium-201 myocardial perfusion imaging in three primary patient populations. Am J Cardiol 1992;70:23E-9E.

    Article  PubMed  CAS  Google Scholar 

  15. Jain D, Lahiri A, Raftery E. Clinical and prognostic significance of lung thallium uptake on rest imaging in acute myocardial infarction. Am J Cardiol 1990;65:154–9.

    Article  PubMed  CAS  Google Scholar 

  16. Chin BB, Moshin J, Bouchard M, et al. Hemodynamic indices of myocardial dysfunction correlate with dipyridamole thallium-201 SPECT. J Nucl Med 1996;37:723–9.

    PubMed  CAS  Google Scholar 

  17. Verani MS. The adenosine saga: one more piece of the puzzle. But does it cause wall motion abnormalities? Circulation 1992;86:1038–40.

    CAS  Google Scholar 

  18. Zafrir N, Dahlberg ST, Villegas BJ, Leppo JA. Prognostic utility of increased pulmonary thallium uptake in patients without ischemia. J Nucl Cardiol 1996;3:301–7.

    Article  PubMed  CAS  Google Scholar 

  19. Beleslin BD, Ostojic M, Djordjevic-Dikic A, et al. Coronary vasodilation without myocardial erection. Eur Heart J 1997;18:1166–74.

    PubMed  CAS  Google Scholar 

  20. Vogel P, Mark W, Apstein CS, et al. Acute alternations in left ventricular diastole chamber stiffness: role of the “erectile” effect of coronary arterial pressure and flow in normal and damaged hearts. Circ Res 1982;51:465–78.

    PubMed  CAS  Google Scholar 

  21. Nussbacher A, Arie S, Kalil R, et al. Mechanism of adenosineinduced elevation of pulmonary capillary wedge pressure in humans. Circulation 1995;92:371–9.

    PubMed  CAS  Google Scholar 

  22. Nagueh SF, Kopelen HA, Zoghbi WA. Effects of adenosine on left ventricular filling dynamics in patients with and without coronary artery disease: a Doppler echocardiographic study. Am Heart J 1998;135:647–54.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Cardiology, Kaplan Hospital, 76100, Rehovot, Israel

    Sorel Goland, Sarah Shimoni, Shay Livschitz, Gaby Loutaty, Orli Azulay, Rosa Levy, Avraham Caspi & Alex Arditi

Authors
  1. Sorel Goland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Shimoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shay Livschitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gaby Loutaty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Orli Azulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosa Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Avraham Caspi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alex Arditi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sorel Goland.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goland, S., Shimoni, S., Livschitz, S. et al. Dipyridamole-induced abnormal Tl-201 lung uptake in patients with normal myocardial perfusion: A marker of increased left ventricular filling pressures. J Nucl Cardiol 11, 305–311 (2004). https://doi.org/10.1016/j.nuclcard.2004.02.006

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.nuclcard.2004.02.006

Key Words

Search

Navigation