Preoperative assessment of coronary artery disease in aortic stenosis: a dipyridamole echocardiographic study.
BACKGROUND
The aim of this study was to establish the feasibility, safety, and diagnostic accuracy of the dipyridamole echocardiography test in patients with severe aortic valve stenosis for noninvasive detection of coexisting coronary artery disease.


METHODS
The high-dose dipyridamole echocardiography test was performed in 52 patients with severe aortic stenosis; all patients also underwent coronary angiography, independent of test results, before cardiac operation.


RESULTS
The dipyridamole echocardiography test was completed without major complications. One patient had transient atrial fibrillation that was reversed by aminophylline. Thirty-one patients (60%) had a negative test result; all had normal coronary arteries. Ten of the 21 patients (48%) with a positive test result had coexisting coronary artery disease. The positive predictive value of the dipyridamole echocardiography test for detection of coronary disease in patients with severe aortic stenosis was 48%. The negative predictive value was 100%. The sensitivity was 100% and the specificity was 74%.


CONCLUSIONS
Dipyridamole echocardiography is a safe and feasible tool in patients with severe aortic stenosis eligible for a cardiac operation. A negative test result reliably rules out a significant stenosis, whereas a positive one is much less accurate in predicting coronary artery disease.
Maffei
S
S
CNR Institute of Clinical Physiology, Pisa, Italy.
Baroni
M
M
Terrazzi
M
M
Paoli
F
F
Ferrazzi
P
P
Biagini
A
A
D001024:Aortic Valve Stenosis / Q000150:complications*; D001794:Blood Pressure / Q000187:drug effects; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D004176:Dipyridamole / Q000009:adverse effects; D004452:Echocardiography / Q000009:adverse effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D004176:Dipyridamole