title: Combined dipyridamole and dobutamine echocardiography in myocardial hibernation: comparison with thallium uptake in patients after percutaneous transluminal coronary revascularization under circulatory support.
abstract: OBJECTIVE
  To investigate the specificity and sensitivity of the combination of dipyridamole and dobutamine echocardiography for predicting functional recovery in patients with reduced ventricular function after coronary angioplasty.
  
  
  METHODS
  Twenty-five patients, mean (SD) age 60.8 (10) years, with previous myocardial infarction (> 3 months), angiographically assessed coronary artery disease, and resting regional dysfunction (left ventricular ejection fraction < 35%) were studied. They underwent rest-redistribution thallium Tl-201 single photon emission computed tomography, and low-dose pharmacologic stress echocardiography with dobutamine (up to 10 microg/kg per minute), ultra low-dose dipyridamole (0.28 mg/kg over 4 minutes), and combined dipyridamole-dobutamine administration.
  
  
  RESULTS
  The rate of agreement between Tl-201 and stress echo was 59% for dipyridamole, 62% for dobutamine, and 71% for combined dipyridamole-dobutamine (P <.05 vs dipyridamole and vs dobutamine). Combined dipyridamole-dobutamine showed a higher sensitivity (89%) than Tl-201, dobutamine, or dipyridamole (84%, 78%, and 80%). Specificity was lower for functional recovery prediction with Tl-201 (60%) compared with dobutamine (89%), dipyridamole (90%), and combined dipyridamole-dobutamine (91%).
  
  
  CONCLUSIONS
  Thallium is more sensitive than dipyridamole or dobutamine; the sensitivity gap is filled with combined dipyridamole-dobutamine. Pharmacologic stress echocardiography is more specific than Tl-201 scintigraphy.
authors.affiliation: Medical Department I, Charité, Berlin, Schumannstrasse 20-21, 10117 Berlin--Germany. adrian.borges@charite.de
authors.forename: A C
authors.initials: AC
authors.lastname: Borges
authors.forename: W S
authors.initials: WS
authors.lastname: Richter
authors.forename: M
authors.initials: M
authors.lastname: Witzel
authors.forename: C
authors.initials: C
authors.lastname: Witzel
authors.forename: A
authors.initials: A
authors.lastname: Grohmann
authors.forename: G
authors.initials: G
authors.lastname: Baumann
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000150:complications / Q000628:therapy*; D004176:Dipyridamole; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000209:etiology; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole