Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Aug;105(2):123-9.
doi: 10.5935/abc.20150051. Epub 2015 May 29.

New exercise-dipyridamole combined test for nuclear cardiology in insufficient effort: appropriate diagnostic sensitivity keeping exercise prognosis

[Article in English, Portuguese]
Inés Vidal  1 , Mario Beretta  1 , Omar Alonso  1 , Fernando Mut  1
Affiliations
Comparative Study

New exercise-dipyridamole combined test for nuclear cardiology in insufficient effort: appropriate diagnostic sensitivity keeping exercise prognosis

[Article in English, Portuguese]
Inés Vidal et al. Arq Bras Cardiol. 2015 Aug.

Erratum in

  • Erratum.
    Arq. Bras. Cardiol.. Arq. Bras. Cardiol.. Arq Bras Cardiol. 2016 May;106(5):452. doi: 10.5935/abc.20160075. Arq Bras Cardiol. 2016. PMID: 27305291 Free PMC article.

Abstract

Background: Myocardial perfusion scintigraphy (MPS) in patients not reaching 85% of the maximum predicted heart rate (MPHR) has reduced sensitivity.

Objectives: In an attempt to maintain diagnostic sensitivity without losing functional exercise data, a new exercise and dipyridamole combined protocol (EDCP) was developed. Our aim was to evaluate the feasibility and safety of this protocol and to compare its diagnostic sensitivity against standard exercise and dipyridamole protocols.

Methods: In patients not reaching a sufficient exercise (SE) test and with no contraindications, 0.56 mg/kg of dipyridamole were IV administered over 1 minute simultaneously with exercise, followed by 99mTc-MIBI injection.

Results: Of 155 patients, 41 had MPS with EDCP, 47 had a SE test (≥ 85% MPHR) and 67 underwent the dipyridamole alone test (DIP). They all underwent coronary angiography within 3 months. The three stress methods for diagnosis of coronary lesions had their sensitivity compared. For stenosis ≥ 70%, EDCP yielded 97% sensitivity, SE 90% and DIP 95% (p = 0.43). For lesions ≥ 50%, the sensitivities were 94%, 88% and 95%, respectively (p = 0.35). Side effects of EDCP were present in only 12% of the patients, significantly less than with DIP (p < 0.001).

Conclusions: The proposed combined protocol is a valid and safe method that yields adequate diagnostic sensitivity, keeping exercise prognostic information in patients unable to reach target heart rate, with fewer side effects than the DIP.

PubMed Disclaimer

Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Schematic representation of the proposed combined protocol
Figure 2
Figure 2
Comparison of diagnostic sensitivity of the three protocols for coronary stenosis ≥ 70% and ≥ 50%.
See this image and copyright information in PMC

References

    1. Iskandrian AS, Heo J, Kong B, Lyons E. Effect of the exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients. J Am Coll Cardiol. 1989;14(6):1477–1486. - PubMed
    1. Verzijlbergen JF, Vermeersch PH, Laarman GJ, Ascoop CA. Inadequate exercise leads to suboptimal imaging. Thallium-201 myocardial perfusion imaging after dypiridamole combined with low-level exercise unmasks ischemia in symptomatic patients with non-diagnostic thallium-201 scans who exercise submaximally. J Nucl Med. 1991;32(11):2071–2078. - PubMed
    1. Heller GV, Ahmed I, Tilkemeier PL, Barbour MM, Garber CE. Influence of exercise intensity on the presence, distribution, and size of thallium-201 defects. Pt 1Am Heart J. 1992;123(4):909–916. - PubMed
    1. Santana-Boado C, Candell-Riera J, Castell-Conesa J, Olona M, Palet-Balart J, Aguadé-Bruix S, et al. Influence of ergometric parameters on the results of myocardial perfusion tomographic scintigraphy. Med Clin (Barc) 1997;109(11):406–409. - PubMed
    1. Snader CE, Marwick TH, Pashkow FJ, Harvey SA, Thomas JD, Lauer MS. Importance of estimated functional capacity as a predictor of all-cause mortality among patients referred for exercise thallium single-photon emission computed tomography: report of 3,400 patients from a single center. J Am Coll Cardiol. 1997;30(3):641–648. - PubMed