BackgroundMyocardial perfusion scintigraphy (MPS) in patients not reaching 85% of the
maximum predicted heart rate (MPHR) has reduced sensitivity.ObjectivesIn an attempt to maintain diagnostic sensitivity without losing functional
exercise data, a new exercise and dipyridamole combined protocol (EDCP) was
developed. Our aim was to evaluate the feasibility and safety of this
protocol and to compare its diagnostic sensitivity against standard exercise
and dipyridamole protocols.MethodsIn patients not reaching a sufficient exercise (SE) test and with no
contraindications, 0.56 mg/kg of dipyridamole were IV administered over 1
minute simultaneously with exercise, followed by 99mTc-MIBI injection.ResultsOf 155 patients, 41 had MPS with EDCP, 47 had a SE test (≥ 85% MPHR) and 67
underwent the dipyridamole alone test (DIP). They all underwent coronary
angiography within 3 months. The three stress methods for diagnosis of
coronary lesions had their sensitivity compared. For stenosis ≥ 70%, EDCP
yielded 97% sensitivity, SE 90% and DIP 95% (p = 0.43). For lesions ≥ 50%,
the sensitivities were 94%, 88% and 95%, respectively (p = 0.35). Side
effects of EDCP were present in only 12% of the patients, significantly less
than with DIP (p < 0.001).ConclusionsThe proposed combined protocol is a valid and safe method that yields
adequate diagnostic sensitivity, keeping exercise prognostic information in
patients unable to reach target heart rate, with fewer side effects than the
DIP.
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