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Dipyridamole angina: a specific symptom of severe multivessel disease
P Dabizzi1, G Barletta, P Lo Sapio
1Department of Internal Medicine, University of Florence, Italy.
Insights
Dipyridamole-induced ischemia during thallium tests often indicates severe coronary artery disease with collateral circulation. While "dipyridamole angina" is specific, its low sensitivity means it may not appear in all affected patients.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Dipyridamole-induced ischemia is linked to angina and ST-segment depression.
- These symptoms predominantly occur in patients with three-vessel disease, collateral vessels, or both.
Purpose of the Study:
- To analyze diagnostic relationships between dipyridamole-induced ischemia, angina, and coronary artery disease.
- To evaluate the significance of dipyridamole angina in conjunction with thallium scintigraphy.
Main Methods:
- Studied 227 consecutive patients undergoing coronary angiography and dipyridamole-thallium scintigraphy.
- Correlated findings of perfusion defects, ECG changes, angina, and coronary anatomy.
Main Results:
- 134 patients had perfusion defects; 46 (34%) showed ST depression, with 12 experiencing 'dipyridamole angina'.
- These 12 patients had three-vessel disease and collateral circulation.
- Among patients with positive dipyridamole-thallium tests, 68% had collateral vessels.
Conclusions:
- Dipyridamole angina during a positive test typically signifies severe coronary stenoses with collateral circulation.
- Dipyridamole angina demonstrates high specificity but low sensitivity as a diagnostic symptom.
Background:
Several studies have indicated that ischemia induced by dipyridamole is frequently associated with angina or ischemic ST-segment depression and that it occurs mainly in patients with three-vessel disease, those with collateral vessels, or those with both.
Methods:
In order to analyze the diagnostic relationships among them, we studied 227 consecutive patients who underwent coronary angiography and dipyridamole-thallium scintigraphy.
Results:
A perfusion defect was found in 134 patients. Of these, 88 patients (66%) showed no significant ECG modifications or angina; 46 (34%) had a transient ST-segment depression, which was associated with typical angina ('dipyridamole angina') in 12. These 12 patients had three-vessel disease with intercoronary collateral circulation. Among the 134 patients with coronary critical stenoses and a positive thallium-dipyridamole test, collateral vessels were detected in 91 (68%).
Conclusion:
Dipyridamole angina, occurring during a positive dipyridamole-thallium test, is usually a manifestation of severe coronary stenoses with collateral circulation. However, as a diagnostic symptom it is characterized by high specificity but low sensitivity.