Paper Information

Title: 

SUSTAINED LEFT VENTRICULAR DYSFUNCTION AFTER DIPYRIDAMOLE INFUSION IN PATIENTS WITH CORONARY ARTERY DISEASE

Type: POSTER
Author(s): DABAGH KAKHAKI V.R.*
 
 *DEPT. OF NUCLEAR MEDICINE, MASHHAD UNIVERSITY OF MEDICAL SCIENCES
 
Name of Seminar: IRANIAN CONGRESS OF PHYSIOLOGY AND PHARMACOLOGY
Type of Seminar:  CONGRESS
Sponsor:  PHYSIOLOGY AND PHARMACOLOGY SOCIETY, MASHHAD UNIVERSITY OF MEDICAL SCIENCE
Date:  2007Volume 18
 
 
Abstract: 

Introduction: Myocardial stunning is defined as a contractile dysfunction that follows an ischemic insult. In addition to dynamic exercise and dobutamine tests, dipyridamole may cause myocardial stunning. We investigated the difference in left ventricular ejection fraction (LVEF) and end-systolic volume measured by gated myocardial perfusion SPECT (GSPECT) in the post-dipyridamole stress and rest periods.
Methods: 297 conscutive patients were studied with post-stress and rest 99mTc-sestamibi GSPECT using a two-day protocol. Stress images were obtained 90 min after dipyridamole infusion.
Results: 129 patients (43.4%) had normal perfusion, 116 (39%) had stress-induced ischemia, and 52(17.5%) had only myocardial infarction. Differences between post-stress LVEF (SEF) and rest LVEF (REF) were +3.39, -4.92 and -1.61 for these three groups respectively (P<0.001). Post-stress stunning (>5% decrease in LVEF) was present in 49 patients (16.5%). SEF was significantly more than REF in patients with no stress-induced ischemia while patients with stress-induced ischemia had lower SEF than REF. No significant difference was seen between post-stress end-systolic volume (SESV) and rest end-systolic volume (RESV) in patients without ischemia while in patients with stress-induced ischemia, SESV was significantly more than RESV.
Conclusion: LVEF decreased slightly but significantly in the post-dipyridamole stress period when an ischemic insult was present, while it has a mild tendency to increase when the myocardial perfusion is normal. Not only exercise stress but also dipyridamole can cause a transient decrease in LVEF in stunned patients, confirming that vasodilators are capable of producing more than simple flow heterogeneity.

 
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