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ORIGINAL ARTICLE
Year : 2016  |  Volume : 26  |  Issue : 4  |  Page : 115-119

Addition of exercise to dipyridamole stress echocardiography in order to carry on the ischemic cascade: Role in the diagnosis of coronary artery disease and prognostic value


1 Department of Cardiology, Camposampiero Hospital, Padua, Italy
2 Department of Cardiology, Ospedali Riuniti Padova Sud, Monselice, Italy
3 Department of Cardiology, San Donà di Piave Hospital, San Donà di Piave, Italy
4 Department of Cardiology, University of Padua, Padua, Italy
5 Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy

Correspondence Address:
Pietro Offelli
Ospedali Riuniti Padova Sud, Via Albere 30, Monselice
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2211-4122.192173

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Background: Sensitivity of dipyridamole stress echocardiography (SE) is often lower than required. The aim of the present work is the evaluation of the association of dipyridamole and exercise echocardiography. Methods: From June 2007 to January 2011, 259 consecutive patients referred to Camposampiero Echocardiography Laboratory underwent SE. Stress protocol started with dipyridamole infusion of 0.84 mg/kg over 6 min. In patients without a new dyssynergy after dipyridamole, SE was carried on with supine exercise. If endocardial border detection was suboptimal, ultrasound contrast agent was used. Coronary angiography was performed in positive patients. The events recorded during the follow-up were cardiac death, nonfatal myocardial infarction (hard events), and coronary revascularization. Results: Of 259 patients, 74 had a positive result: 37 were positive after infusion of dipyridamole, and 37 became positive during exercise. All 74 positive patients underwent coronary angiography: 67 had significant coronary artery disease (36 positive with dipyridamole, and 31 positive with exercise), and 7 had not significant artery disease. In positive patients, the coronary revascularizations were 40. Furthermore, 3 of the 185 negative patients underwent coronary revascularization. During follow-up of 20 ± 10 months, 6 (8.1%) hard events occurred in positive patients. No hard event was observed in negative patients. Conclusions: Dipyridamole SE with the addition of exercise can be proposed as a strategy to carry on the ischemic cascade and to identify the patients who elude the dipyridamole alone SE. A negative result is suggestive of a very good prognosis, free from hard events at 20 ± 10 months.


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