ST-segment depression during dipyridamole infusion, and its clinical, scintigraphic and hemodynamic correlates

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Abstract

The goal of this study was to determine whether dipyridamole-induced ST-segment depression reflects more severe or extensive myocardial hypoperfusion than the absence of this electrocardiographic finding. The clinical, hemodynamic and scintigraphic correlates of ST-segment depression during intravenous dipyridamole infusion were studied in 204 consecutive patients undergoing dipyridamole stress thallium-201 (Tl-201) imaging for evaluation of coronary artery disease. Of 182 patients with a diagnostic baseline electrocardiogram, 28 (15%) developed ST depression after dipyridamole. Patients with ST depression, compared with those without, were older (64 ± 1 vs 60 ± 1 years; p < 0.03) and had a higher frequency of chest pain (57 vs 23%; p < 0.001) and a higher heart rate-blood pressure product (12.7 ± 0.6 vs 11.2 ± 0.2 × 103; p < 0.008) after dipyridamole. Patients with ST depression were more likely to have Tl-201 redistribution (64 vs 38%; p < 0.02) and a greater number of redistribution defects (2.3 ± 0.04 vs 0.9 ± 0.1, p < 0.001) than were those without ST depression.

By multivariate logistic regression analysis, the most powerful correlate of ST depression was the number of segments having Tl-201 redistribution (p < 0.001). Other independent correlates were presence of chest pain, heart rate at Tl-201 injection, and age. Thus, the determinants of dipyridamole-induced ST-segment depression include the scintigraphic extent of reversible hypoperfusion, as well as indexes of myocardial oxygen demand.

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    This study was supported in part by Grant R01 HL26205-09 from the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland.

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