DIPYRIDAMOLE ELECTROCARDIOGRAPHY TEST FOR THE ASSESSMENT OF THE SEVERITY OF CORONARY ARTERY DISEASE

• Published in: JAPANESE CIRCULATION JOURNAL Vol. 56; no. 3; pp. 223 - 234
• Main Authors: YASUI, SHOJI, IKEDA, KOZUE, KUBOTA, ISAO, YAMAKI, MICHIYASU, KATO, NAOMI, HOSOYA, YUKIO, TOMOIKE, HITONOBU
• Format: Journal Article
• Language: English
• Published: Kyoto The Japanese Circulation Society 1992; Japanese Circulation Society; 社団法人日本循環器学会
• Subjects: Adult; Aged; Biological and medical sciences; Blood Pressure; Cardiology. Vascular system; Coronary Angiography; Coronary Disease - diagnosis; Coronary heart disease; Dipyridamole; Electrocardiography; Exercise Test; Female; Heart; Heart Rate; Humans; Male; Medical sciences; Middle Aged; Myocardial ischemia; Number of diseased coronary artery; Predictive Value of Tests; Sensitivity and Specificity; Severity of Illness Index; ST depression; Human; Electrodiagnosis; Ischemia; Electrocardiography; Myocardium; Digestive diseases; Exploration; Coronary heart disease
• ISSN: 0047-1828; 1347-4839
• DOI: 10.1253/jcj.56.223

The purpose of this study was to investigate the relationship of dipyridamole-induced ST changes to the severity of coronary artery disease. The subjects were 100 patients without myocardial infarction who underwent coronary arteriography for the diagnosis of coronary artery disease. The dipyridarnole injection test (D) (0.568 mg/kg/4 min), and symptom-limited treadmill exercise test (T) were performed separately. Body surface electrocardiographic mapping of 87 leads was performed in both tests. The incidences of significant ST depression ≤ 0.10 mV, number of leads showing significant ST depression (nST) and the maximal voltage of ST depression (maxST) in D and T were compared to the number of diseased coronary arteries. In patients without significant coronary stenosis (0VD group), the incidence of ST depression in the dipyridamole test was significantly lower than that in the treadmill test (D 9% vs T 47%, p<0.01). While, in one vessel disease (1VD), two vessel disease (2VD), and three vessel disease (3VD)groups, there was no significant difference in the incidence of ST depression between the dipyridamole test and the treadmill test (in 1VD, D 44% vs. T 65%; in 2VD, D 67% vs. T 93%; and in 3VD D 93% vs. T, 96%). In the dipyridamole test, nST was 0.6±2.4 in 0VD, 4.5±6.9 in 1VD, 4.1±4.5 in 2VD, and 10.6±8.1 in 3VD. Significant differences were found between 0VD and 1VD (P<0.05), 0VD and 3VD (P<0.01). 1VD and 3VD (P<0.01), and 2VD and 3VD (p<0.01). The maxST in the dipyridamole test was 0.02±0.04 mV in 0VD, 0.10±0.12 mV in 1VD. 0.13±0.11 mV in 2VD, and 0.22±0.11 mV in 3VD. Significant differences were found between 0VD and 1VD (p<0.01), 0VD and 2VD (p<0.01), 0VD and 3VD (p<0.01), 1VD and 3VD (p<0.01), and 2VD and 3VD (P<0.01). For the diagnosis of 3VD, the dipyridamole ECG test had as high a sensitivity (93% vs 96%), higher specificity (68% vs 38%, p<0.01), and higher predictive accuracy (75% vs 54%, p<0.01) than the treadmill test. For the detection of one or more stenotic coronary arteries, the dipyridamole test had a lower sensitivity (70% vs 85%, p<0.05), but higher specificity (91% vs 53%, p< 0.01), and as high a predictive accuracy (77% vs 74%) compared with the treadmill test. This study demonstrated that the dipyridamole ECG test was useful in stratifying the severity of coronary artery disease. Dipyridamole ECG was both sensitive and specific for the detection of 3VD.