Dipyridamole Echocardiography in Essential Hypertensive Patients with Chest Pain

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 1988-09, Vol.12 (3), p.238-243
• Main Authors: PLCANO, EUGENIO, LUCARINI, ALESSANDRA RENATA, LATTANZI, FABIO, DISTANTE, ALESSANDRO, DI LEGGE, VIRGILIO, SALVETTI, ANTONIO, LʼABBATE, ANTONIO
• Format: Article
• Language: English
• Subjects: Angiography; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chest Pain - diagnosis; Chest Pain - etiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Coronary Disease - diagnosis; Coronary Disease - diagnostic imaging; Dipyridamole - adverse effects; Echocardiography - methods; Exercise Test; Feasibility Studies; Female; Humans; Hypertension - complications; Male; Medical sciences; Middle Aged
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.HYP.12.3.238

The exerdse-electrocardiography test shows limited feasibility and diagnostic accuracy for the ooninvaslve detection of coronary artery disease in hypertensive patients. Recently, the dipyridamoleechocardiography test (two-dimensional echocardtographic monitoring with dipyridamole infusion, up to 0.84 mg/kg over 10 minutes) has been proposed as an exercise-independent method for the diagnosis of coronary artery disease. The diagnostic usefulness of the exerdse-electrocardiography test and the dipyridamole-echocardiography test was evaluated in 63 consecutive inpatients with history of chest pain, essential hypertension, and no previous myocardial infarction. The criterion of posltlvity for the exerdse-electrocardiography test was a horizontal or downsioping ST segment shift exceeding 0.1 mV and for the dipyridamole-echocardiography test, a transient dyssynergy of contraction. Fifteen patients could not perform a diagnostic exerdse-electrocardiography test because of an nubility to exercise adequately (two patients), severe hypertension in spite of full antihypertensive therapy (six patients), or excessive blood pressure rise at the first step of the exercise-electrocardiography test (seven patients). Five patients could not perform the dipyridamole-echocardiography test because of a poor acoustic window. The overall feasibility was 76% for the exercise-electrocardiography test and 92% for the dipyridamoleechocardiography test (p < 0.05). All 43 patients who performed both tests underwent coronary angiography; 30 had significant coronary artery disease (>70% lumen reduction of at least 1 major coronary vessel). Sensitivity was 67% for both the exercise-electrocardiography test and the dipyridamoleechocardiography test (p = NS); spedfidty was 46% for the exerdse-electrocardiography test and 92% for the dipyridamole-echocardiography test {p < 0.05). Thus, the dipyridamole-echocardiography test represents a good diagnostic alternative to the exercise-electrocardiography test in symptomatic hypertensive patients, as it has a similar sensitivity and higher feasibility and spedfidty for the detection of coronary artery disease.