Combined low dose dipyridamole-dobutamine stress echocardiography to identify myocardial viability

Eugenio Picano, Miodrag Ostojic, A. Varga, Rosa Sicari, Ana Djordjevic-Dikic, Ivana Nedeljkovic, Marco Torres

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Abstract

Objectives. We sought to evaluate the effects of combined administration of infra-low dose dipyridamole and low dose dobutamine on assessment of myocardial viability. Background. Low dose pharmacologic stress echocardiography with either dobutamine or dipyridamole infusion has been proposed for the recognition of myocardial viability. Methods. Thirty-four patients with rest wall motion dyssynergy by two-dimensional echocardiography and with angiographically proved coronary artery disease underwent in combination with two-dimensional echocardiographic monitoring: 1) low dose (5 to 10 μg/kg per min over 3 min) dobutamine infusion; 2) infra-low dose (0.28 mg/kg over 4 min) dipyridamole infusion; 3) combination of infra-low dose dipyridamole infusion immediately followed by low dose dobutamine infusion (combined dipyridamole-dobutamine). Results. Follow-up rest echocardiography was available in 30 patients. After revascularization, 82 segments showed a contractile improvement of ≥ 1 grade, whereas 63 segments remained unchanged. The sensitivity of dobutamine, dipyridamole and combined dipyridamole-dobutamine for predicting recovery was 72% (95% confidence interval [CI] 60.9% to 81.3%), 67% (CI 55.8% to 77%) and 94% (CI 86.3% to 97.9%), respectively. The specificity of dipyridamole, dobutamine and combined dipyridamole-dobutamine was 95% (CI 86.7% to 99%), 92% (CI 82.4% to 97.3%) and 89% (CI 78.4% to 95.4%), respectively. The accuracy of the dobutamine, dipyridamole and combined dipyridamole-dobutamine test was 80%, 79% and 92%, respectively (combined dipyridamole-dobutamine vs. dobutamine, p <0.05; combined dipyridamole-dobutamine vs. dipyridamole, p <0.01). Conclusions. Infra-low dose dipyridamole added to low dose dobutamine recruits an inotropic reserve in asynergic segments that were nonresponders after either dobutamine or dipyridamole alone and destined to recover after revascularization.

Original languageEnglish
Pages (from-to)1422-1428
Number of pages7
JournalJournal of the American College of Cardiology
Volume27
Issue number6
DOIs
Publication statusPublished - May 1996

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Stress Echocardiography
Dobutamine
Dipyridamole
Confidence Intervals
Echocardiography

ASJC Scopus subject areas

  • Nursing(all)

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Combined low dose dipyridamole-dobutamine stress echocardiography to identify myocardial viability. / Picano, Eugenio; Ostojic, Miodrag; Varga, A.; Sicari, Rosa; Djordjevic-Dikic, Ana; Nedeljkovic, Ivana; Torres, Marco.

In: Journal of the American College of Cardiology, Vol. 27, No. 6, 05.1996, p. 1422-1428.

Research output: Contribution to journalArticle

Picano, Eugenio ; Ostojic, Miodrag ; Varga, A. ; Sicari, Rosa ; Djordjevic-Dikic, Ana ; Nedeljkovic, Ivana ; Torres, Marco. / Combined low dose dipyridamole-dobutamine stress echocardiography to identify myocardial viability. In: Journal of the American College of Cardiology. 1996 ; Vol. 27, No. 6. pp. 1422-1428.
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title = "Combined low dose dipyridamole-dobutamine stress echocardiography to identify myocardial viability",
abstract = "Objectives. We sought to evaluate the effects of combined administration of infra-low dose dipyridamole and low dose dobutamine on assessment of myocardial viability. Background. Low dose pharmacologic stress echocardiography with either dobutamine or dipyridamole infusion has been proposed for the recognition of myocardial viability. Methods. Thirty-four patients with rest wall motion dyssynergy by two-dimensional echocardiography and with angiographically proved coronary artery disease underwent in combination with two-dimensional echocardiographic monitoring: 1) low dose (5 to 10 μg/kg per min over 3 min) dobutamine infusion; 2) infra-low dose (0.28 mg/kg over 4 min) dipyridamole infusion; 3) combination of infra-low dose dipyridamole infusion immediately followed by low dose dobutamine infusion (combined dipyridamole-dobutamine). Results. Follow-up rest echocardiography was available in 30 patients. After revascularization, 82 segments showed a contractile improvement of ≥ 1 grade, whereas 63 segments remained unchanged. The sensitivity of dobutamine, dipyridamole and combined dipyridamole-dobutamine for predicting recovery was 72{\%} (95{\%} confidence interval [CI] 60.9{\%} to 81.3{\%}), 67{\%} (CI 55.8{\%} to 77{\%}) and 94{\%} (CI 86.3{\%} to 97.9{\%}), respectively. The specificity of dipyridamole, dobutamine and combined dipyridamole-dobutamine was 95{\%} (CI 86.7{\%} to 99{\%}), 92{\%} (CI 82.4{\%} to 97.3{\%}) and 89{\%} (CI 78.4{\%} to 95.4{\%}), respectively. The accuracy of the dobutamine, dipyridamole and combined dipyridamole-dobutamine test was 80{\%}, 79{\%} and 92{\%}, respectively (combined dipyridamole-dobutamine vs. dobutamine, p <0.05; combined dipyridamole-dobutamine vs. dipyridamole, p <0.01). Conclusions. Infra-low dose dipyridamole added to low dose dobutamine recruits an inotropic reserve in asynergic segments that were nonresponders after either dobutamine or dipyridamole alone and destined to recover after revascularization.",
author = "Eugenio Picano and Miodrag Ostojic and A. Varga and Rosa Sicari and Ana Djordjevic-Dikic and Ivana Nedeljkovic and Marco Torres",
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T1 - Combined low dose dipyridamole-dobutamine stress echocardiography to identify myocardial viability

AU - Picano, Eugenio

AU - Ostojic, Miodrag

AU - Varga, A.

AU - Sicari, Rosa

AU - Djordjevic-Dikic, Ana

AU - Nedeljkovic, Ivana

AU - Torres, Marco

PY - 1996/5

Y1 - 1996/5

N2 - Objectives. We sought to evaluate the effects of combined administration of infra-low dose dipyridamole and low dose dobutamine on assessment of myocardial viability. Background. Low dose pharmacologic stress echocardiography with either dobutamine or dipyridamole infusion has been proposed for the recognition of myocardial viability. Methods. Thirty-four patients with rest wall motion dyssynergy by two-dimensional echocardiography and with angiographically proved coronary artery disease underwent in combination with two-dimensional echocardiographic monitoring: 1) low dose (5 to 10 μg/kg per min over 3 min) dobutamine infusion; 2) infra-low dose (0.28 mg/kg over 4 min) dipyridamole infusion; 3) combination of infra-low dose dipyridamole infusion immediately followed by low dose dobutamine infusion (combined dipyridamole-dobutamine). Results. Follow-up rest echocardiography was available in 30 patients. After revascularization, 82 segments showed a contractile improvement of ≥ 1 grade, whereas 63 segments remained unchanged. The sensitivity of dobutamine, dipyridamole and combined dipyridamole-dobutamine for predicting recovery was 72% (95% confidence interval [CI] 60.9% to 81.3%), 67% (CI 55.8% to 77%) and 94% (CI 86.3% to 97.9%), respectively. The specificity of dipyridamole, dobutamine and combined dipyridamole-dobutamine was 95% (CI 86.7% to 99%), 92% (CI 82.4% to 97.3%) and 89% (CI 78.4% to 95.4%), respectively. The accuracy of the dobutamine, dipyridamole and combined dipyridamole-dobutamine test was 80%, 79% and 92%, respectively (combined dipyridamole-dobutamine vs. dobutamine, p <0.05; combined dipyridamole-dobutamine vs. dipyridamole, p <0.01). Conclusions. Infra-low dose dipyridamole added to low dose dobutamine recruits an inotropic reserve in asynergic segments that were nonresponders after either dobutamine or dipyridamole alone and destined to recover after revascularization.

AB - Objectives. We sought to evaluate the effects of combined administration of infra-low dose dipyridamole and low dose dobutamine on assessment of myocardial viability. Background. Low dose pharmacologic stress echocardiography with either dobutamine or dipyridamole infusion has been proposed for the recognition of myocardial viability. Methods. Thirty-four patients with rest wall motion dyssynergy by two-dimensional echocardiography and with angiographically proved coronary artery disease underwent in combination with two-dimensional echocardiographic monitoring: 1) low dose (5 to 10 μg/kg per min over 3 min) dobutamine infusion; 2) infra-low dose (0.28 mg/kg over 4 min) dipyridamole infusion; 3) combination of infra-low dose dipyridamole infusion immediately followed by low dose dobutamine infusion (combined dipyridamole-dobutamine). Results. Follow-up rest echocardiography was available in 30 patients. After revascularization, 82 segments showed a contractile improvement of ≥ 1 grade, whereas 63 segments remained unchanged. The sensitivity of dobutamine, dipyridamole and combined dipyridamole-dobutamine for predicting recovery was 72% (95% confidence interval [CI] 60.9% to 81.3%), 67% (CI 55.8% to 77%) and 94% (CI 86.3% to 97.9%), respectively. The specificity of dipyridamole, dobutamine and combined dipyridamole-dobutamine was 95% (CI 86.7% to 99%), 92% (CI 82.4% to 97.3%) and 89% (CI 78.4% to 95.4%), respectively. The accuracy of the dobutamine, dipyridamole and combined dipyridamole-dobutamine test was 80%, 79% and 92%, respectively (combined dipyridamole-dobutamine vs. dobutamine, p <0.05; combined dipyridamole-dobutamine vs. dipyridamole, p <0.01). Conclusions. Infra-low dose dipyridamole added to low dose dobutamine recruits an inotropic reserve in asynergic segments that were nonresponders after either dobutamine or dipyridamole alone and destined to recover after revascularization.

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