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Absolute quantitation of coronary steal induced by intravenous dipyridamole

O O Akinboboye1, O Idris, R L Chou

  • 1Nuclear Cardiology Laboratory, St. Francis Hospital, Roslyn, New York 11576, USA.

Journal of the American College of Cardiology
|January 12, 2001
PubMed

Insights

Intravenous dipyridamole can induce coronary steal, a decrease in blood flow, in nearly half of patients with severe coronary artery disease (CAD). This finding is crucial for understanding myocardial ischemia during vasodilation in CAD patients.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Cardiovascular Imaging

Background:

  • Myocardial ischemia during vasodilation is often linked to coronary steal.
  • Limited data exists on the absolute magnitude of coronary steal in humans.

Purpose of the Study:

  • To determine if intravenous (IV) dipyridamole induces coronary steal in patients with severe coronary artery disease (CAD).
  • To quantify the absolute decrease in myocardial perfusion during dipyridamole infusion.

Main Methods:

  • Eighteen patients with multivessel CAD underwent dynamic positron emission tomography (PET) with 13NH3.
  • Myocardial blood flow was assessed at rest and after IV dipyridamole infusion.
  • Myocardial blood flow was calculated in absolute terms using a two-compartment model.

Main Results:

  • Coronary steal was observed in 8 out of 18 patients (approximately 45%).
  • In patients with steal, myocardial blood flow decreased from 90 +/- 18 to 68 +/- 27 ml/100 g/min.
  • Segments without steal showed increased blood flow (87 +/- 19 to 138 +/- 16 ml/100 g/min).
  • Clinical correlates included ST elevation or ST depression with angina.

Conclusions:

  • Intravenous dipyridamole causes significant reductions in blood flow to collateral-dependent myocardium in severe CAD.
  • These reductions are consistent with coronary steal in a substantial proportion of patients.
  • Findings highlight the importance of assessing absolute myocardial blood flow to detect coronary steal.
Abstract

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