Influence of chronic renal failure on the heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT.
BACKGROUND
Dipyridamole promotes a reduction in blood pressure and an increase in heart rate (HR), considered the normal hemodynamic response to the drug. Data suggest that patients with chronic renal failure (CRF) have an attenuation of this hemodynamic response. This study sought to evaluate the HR response to dipyridamole and its determinants in patients with or without CRF undergoing gated myocardial perfusion single photon emission computed tomography.


RESULTS
Consecutive patients (n = 355, 9.6% with CRF) undergoing rest/dipyridamole myocardial perfusion single photon emission computed tomography were evaluated. The HR response to dipyridamole was considered to be reduced if the HR ratio (maximal HR/rest HR) was 1.20 or less. A logistic regression analysis determined independent predictors of a blunted HR response. A reduced HR response was found in 84.4% of patients with CRF and 40.6% of those without CRF (P < .0001). In patients without CRF the independent predictors of abnormal HR response were hypertension, rest and differential perfusion scores, and left ventricular ejection fraction. In contrast, in CRF patients there was no significant association of any of the studied variables with abnormal HR response.


CONCLUSIONS
An abnormal HR response to dipyridamole is frequently found in patients with CRF. Different mechanisms may account for abnormal HR response in patients with or without CRF.
De Lorenzo
Andrea
A
Hospital Universitário Clementino Fraga Filho-Universidade Federal de Rio de Janeiro, Rio de Janeiro, Brazil. andlorezo@hotmail.com
Lima
Ronaldo S L
RS
D000368:Aged; D003951:Diagnostic Errors / Q000517:prevention & control*; D004176:Dipyridamole / Q000008:administration & dosage; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
D014665:Vasodilator Agents; D004176:Dipyridamole