title: Underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium-201 single-photon emission computed tomographic myocardial perfusion imaging in patients taking antianginal drugs.
abstract: OBJECTIVE
  This study evaluated the diagnostic value of dipyridamole plus low level treadmill exercise (dipyridamole stress) thallium-201 single-photon emission computed tomography (SPECT) in patients taking antianginal drugs.
  
  
  BACKGROUND
  Dipyridamole stress is the major substitute for maximal exercise in patients referred for myocardial perfusion imaging. Although antianginal drugs are commonly suspended before exercise, dipyridamole stress is usually performed without discontinuing these drugs.
  
  
  METHODS
  Twenty-six patients underwent two dipyridamole perfusion studies: the first without (SPECT-1) and the second with (SPECT-2) antianginal treatment. Twenty-one patients (81%) received calcium antagonists, 19 (73%) received nitrates, and 8 (31%) received beta-blockers. Eighteen of the patients underwent coronary angiography. Data are presented as the mean value +/- SD.
  
  
  RESULTS
  Visual scoring yielded significantly larger and more severe reversible perfusion defects for SPECT-1 than for SPECT-2. Quantitative analysis showed larger perfusion defects on stress images of SPECT-1 in the left anterior descending coronary artery (LAD) (25 +/- 21% vs. 17 +/- 15%, p = 0.003), left circumflex coronary artery (LCx) (56 +/- 35% vs. 48 +/- 36%, p = 0.03) and right coronary artery (RCA) (36 +/- 27% vs. 25 +/- 24%, p = 0.008) territories. Individual vessel sensitivities in the LAD, LCx and RCA territories were 93%, 79% and 100% for SPECT-1 and 64%, 50% and 70% for SPECT-2, respectively. These differences were highly significant for the LAD (p = 0.004) and LCx (p = 0.00004) territories. The overall individual vessel sensitivity of SPECT-1 was significantly higher than that of SPECT-2 (92% vs. 62%, p = 0.000003). Specificity was not significantly different in SPECT-1 compared with SPECT-2 (80% and 93%, p = 0.33).
  
  
  CONCLUSIONS
  Continued use of antianginal drugs before dipyridamole plus low level treadmill exercise thallium-201 SPECT may reduce the extent and severity of myocardial perfusion defects, resulting in underestimation of coronary artery disease.
authors.affiliation: Nuclear Cardiology Unit, Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Sharir
authors.forename: B
authors.initials: B
authors.lastname: Rabinowitz
authors.forename: S
authors.initials: S
authors.lastname: Livschitz
authors.forename: I
authors.initials: I
authors.lastname: Moalem
authors.forename: J
authors.initials: J
authors.lastname: Baron
authors.forename: E
authors.initials: E
authors.lastname: Kaplinsky
authors.forename: P
authors.initials: P
authors.lastname: Chouraqui
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004176:Dipyridamole; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D000319:Adrenergic beta-Antagonists; D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D004176:Dipyridamole