[Diagnosis of ischemic heart disease by dipyridamole-stress two-dimensional echocardiography]

The diagnostic usefulness of dipyridamole-stress two-dimensional echocardiography was assessed in 82 patients consisting of 27 patients with angina pectoris, 42 with myocardial infarction, and 13 control subjects. Two-dimensional echocardiographic monitoring was performed during dipyridamole infusion: 0.56 mg/kg for 4 minutes, then discontinuation for 4 minutes, followed by a final infusion of 0.28 mg/kg for 2 minutes. The cumulative dose was 0.84 mg/kg. Worsening or fixed wall motion abnormality with unaffected baseline indicated a positive finding. All patients underwent coronary angiography. The sensitivity and specificity of dipyridamole-stress two-dimensional echocardiography for diagnosis of significant coronary artery stenosis (> or = 75%) were 84% (58/69) and 92% (12/13), respectively. The sensitivity of this method for the branches of the coronary artery was 85% for the left anterior descending artery, 80% for the right coronary artery, and 75% for the left circumflex artery. The sensitivity for single-, double-, triple-vessel disease was 75%, 81% and 100%, respectively. The sensitivity and specificity of the dipyridamole electrocardiogram (ST depression more than 0.1 mV) were 33% (23/69) and 77% (10/13), respectively. The appearance of dipyridamole-stress induced wall motion abnormality was significantly earlier than those of chest pain and ST segment depression. Side effects were observed in 43% (35/82) of patients, but were only mild and transient. Dipyridamole-stress two-dimensional echocardiography is the best method for detecting coronary artery stenosis and predicting the localization of lesion sites.