Safety and diagnostic accuracy of dipyridamole-thallium imaging in the elderly

Abstract

The noninvasive diagnosis of coronary artery disease in the elderly can occasionally be difficult. Intravenous dipyridamole-thallium imaging is a potentially useful diagnostic test to determine presence and severity of coronary disease; however, the safety of the procedure has not been determined in an older population. The side effect profile and frequency of severe ischemic responses after 0.56 mg/kg of intravenous dipyridamole were compared in 101 patients greater than or equal to 70 years old and 236 patients less than 70 years old. There were no side effects in 64% and 62% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). Among the 337 patients tested, there were no complications of myocardial infarction or death. The most common cardiac side effect was chest pain, which occurred in 21 (21%) of the 101 patients aged greater than or equal to 70 years and in 64 (27%) of the 236 patients less than 70 years (p = NS). Aminophylline was required to reverse cardiac or noncardiac side effects in 15 (15%) and 36 (15%) of the patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). A severe ischemic response occurred in 2% and 2.5% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). The sensitivity of intravenous dipyridamole-thallium imaging for obstructive coronary artery disease was 86% (25 of 29) and 83% (68 of 82) in older and younger patients, respectively (p = NS); the specificity was 75% (6 of 8) and 70% (16 of 23), respectively (p = NS). Thus, intravenous dipyridamole-thallium imaging is a safe noninvasive method for assessment of older patients with obstructive coronary disease; its side effect profile and diagnostic accuracy are similar to those seen in younger patients. The technique is associated with severe ischemic responses in only a small minority of patients.

Direct or indirect stimulation of adenosine A 2A receptors enhances bone regeneration as well as bone morphogenetic protein‐2

“…The topical application of adenosine receptor agonists or agents that increase endogenous adenosine levels has the advantage that the effects of the agents are concentrated locally and that fewer systemic toxicities develop because little of the agent is released systemically. Moreover, dipyridamole has been used systemically (both orally and intravascularly in patients) for decades with little systemic toxicity; the occurrence of severe drug-related adverse effects, including cardiac death, sustained ventricular arrhythmia, cerebral ischemic attack, stroke, or severe bronchospasm, is ,0.02% of patients taking systemic doses of the agent (53,54).…”

The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Intravenous Dipyridamole Thallium Imaging Study Group.

“…After the collection of clinical data for submission to regulatory authorities in the United States, additional studies were published that demonstrate the diagnostic usefulness of dipyridamole-thallium scintigraphy. 8,9 This study focuses on the safety of dipyridamole-thallium scintigraphy with an analysis of the clinical safety data that were collected from investigators in the United States who had performed thallium myocardial imaging using intravenous dipyridamole.…”

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

“…It is more than likely that some of these patients had coexisting carotidartery disease. Finally, the safety of intravenous dipyri damole TMI has also been assessed in coronary patients older than 70 years in whom carotid-artery disease is even more probable [32], In previous studies, dipyridamole TMI was employed for the detection of IHD in patients with peripheral or abdominal aortic vascular disease [33][34][35][36][37], In all studies, it was found to have prognostic utility for risk stratifica tion before vascular surgery. The risk of perioperative events, i.c.…”