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      Dipyridamole Myocardial Perfusion Tomography in Patients with Severe Aortic Stenosis


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          Patients with aortic stenosis (AS) may have classic angina pectoris. The safety of exercise testing in adults with AS is controversial and, in fact, exercise testing in such patients is considered to be contraindicated especially in severe aortic stenosis (SAS). Furthermore, exercise testing has low specificity in uncovering coronary artery disease (CAD) in patients with AS, because the baseline ECG is frequently abnormal. We wished to assess the safety and diagnostic accuracy of dipyridamole stress myocardial perfusion tomography (DMPT) in the detection of CAD in patients with SAS. Methods: The study included 30 patients with SAS (mean aortic valve area 0.57 ± 0.09 cm<sup>2</sup>). All patients underwent dipyridamole myocardial perfusion scintigraphy (SPECT), coronary arteriography and catheterization, as well as Doppler echocardiography. Myocardial perfusion tomography was applied with <sup>99m</sup>Tc hexakis-2-methoxyisobutyl isonitrile (MIBI) by a single day rest-dipyridamole infusion protocol. Hemodynamic, electrocardiographic and clinical responses were compared with those of 50 control patients without AS. Results: Hemodynamic responses during dipyridamole stress tests demonstrated no significant differences between the controls and the AS patients in the following parameters: systolic blood pressure, heart rate, rate-pressure product or incidence of headache, chest pain, dyspnea, flushing and dizziness. A reversible perfusion defect was observed in 10 patients with DMPT. The existence of coronary lesions was determined by coronary arteriography in 8 of 10 patients (sensitivity 100%, specificity 91%). Conclusion: The results showed that DMPT is well tolerated, even by patients with SAS and is of high diagnostic value in assessing CAD.

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          Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.

          To determine the accuracy of echocardiographic left ventricular (LV) dimension and mass measurements for detection and quantification of LV hypertrophy, results of blindly read antemortem echocardiograms were compared with LV mass measurements made at necropsy in 55 patients. LV mass was calculated using M-mode LV measurements by Penn and American Society of Echocardiography (ASE) conventions and cube function and volume correction formulas in 52 patients. Penn-cube LV mass correlated closely with necropsy LV mass (r = 0.92, p less than 0.001) and overestimated it by only 6%; sensitivity in 18 patients with LV hypertrophy (necropsy LV mass more than 215 g) was 100% (18 of 18 patients) and specificity was 86% (29 of 34 patients). ASE-cube LV mass correlated similarly to necropsy LV mass (r = 0.90, p less than 0.001), but systematically overestimated it (by a mean of 25%); the overestimation could be corrected by the equation: LV mass = 0.80 (ASE-cube LV mass) + 0.6 g. Use of ASE measurements in the volume correction formula systematically underestimated necropsy LV mass (by a mean of 30%). In a subset of 9 patients, 3 of whom had technically inadequate M-mode echocardiograms, 2-dimensional echocardiographic (echo) LV mass by 2 methods was also significantly related to necropsy LV mass (r = 0.68, p less than 0.05 and r = 0.82, p less than 0.01). Among other indexes of LV anatomy, only measurement of myocardial cross-sectional area was acceptably accurate for quantitation of LV mass (r = 0.80, p less than 0.001) or diagnosis of LV hypertrophy (sensitivity = 72%, specificity = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)

            Author and article information

            S. Karger AG
            March 2002
            07 March 2002
            : 97
            : 1
            : 37-42
            Departments of aNuclear Medicine, and bCardiology, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
            47417 Cardiology 2002;97:37–42
            © 2002 S. Karger AG, Basel

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            Page count
            Figures: 2, Tables: 2, References: 32, Pages: 6
            Noninvasive and Diagnostic Cardiology

            General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
            Myocardial perfusion tomography,Dipyridamole,Severe aortic stenosis


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