Noninvasive Screening for Silent Ischemic Heart Disease in Patients with Cerebral Ischemia: Use of Dipyridamole-Thallium Myocardial Imaging

Abstract

To evaluate the incidence of silent ischemic heart disease in cerebrovascular patients unable to exercise, we performed intravenous dipyridamole-thallium myocardial imaging in 38 consecutive patients with stroke without angina or previous myocardial infarction. Dipyridamole was injected intravenously at the dosage of 0.56 mg/kg over 4 min, followed by 4 min of handgrip exercise. Of the 38 patients, 35 had severe atherosclerotic lesions of the internal carotid artery and 3 occlusion of the middle cerebral artery. Dipyridamole-thallium myocardial imaging was normal in 15 patients and abnormal in 23 (60%): reversible perfusion defects were detected in 21 cases and fixed defects in 2. Minor side-effects were observed in 5 patients; no neurologic complications occurred. In conclusion, our findings suggest that in a large proportion of patients with severe large-artery occlusive cerebrovascular disease, a silent ischemic heart disease is present. Dipyridamole-thallium myocardial imaging can be proposed as a safe and valuable examination in the noninvasive cardiac screening of those cerebrovascular patients unable to exercise.

Preoperative noninvasive coronary risk stratification in candidates for carotid endarterectomy.

“…Therefore, in the past decade, more attention was directed to testing that did not require exercise, ie, dipyridamole-thallium imaging or echocardiography. 19 Nevertheless, the accuracy of dipyridamole-thallium scintigraphy in the prediction of cardiac risk after vascular surgery has been strongly challenged by the most recent studies. 2022 In our experience, most candidates for carotid endarterectomy without known CAD are able to exercise (83% in our series).…”

Guidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association.

“…5053 Ischemic heart disease is the most frequent cause of death in elderly patients with TIA; hence its optimal management is an important part of care. Although asymptomatic coronary artery disease may identify patients with TIA who are at risk for cardiac death, 50 it is unclear whether diagnostic investigation to detect silent myocardial ischemia in patients with TIA who do not have symptoms or electrocardiographic evidence of coronary artery disease will lead to improved outcome. 31 …”