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Vol 14, No 1 (2019)
Original Papers
Published online: 2019-04-10
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Safety of patients diagnosed with myocardial perfusion scintigraphy with dipyridamole stress — drawing the issue to the attention

Marek Cacko, Ryszard Tomasiuk, Andrzej Cacko, Monika Gawałko, Gabriela Parol, Michał Nieciecki, Leszek Królicki
DOI: 10.5603/FC.2019.0006
·
Folia Cardiologica 2019;14(1):13-18.

open access

Vol 14, No 1 (2019)
Original Papers
Published online: 2019-04-10

Abstract

Introduction. Myocardial perfusion scintigraphy (MPS) with dipyridamole is an accepted method for assessment of is- chaemic heart disease, in case of contraindication to exercise testing. However, very often we observe clinical symptoms and changes in ECG while monitoring patients during the study with pharmacologic stress with dipyridamole. The aim of this study was to investigate the safety of patients diagnosed with MPS with dipyridamole. 

Material and methods. Twenty-five patients with stable coronary artery disease participated in a 2-day protocol (0.56 mg/ kg dipyridamole i.v. and then rest) using Tc-MIBI imaging. Continuous clinical monitoring and 12-lead serial ECG has been used since the beginning of the MPS up to 20 minutes after the examination. High-sensitive cardiac troponin I (hscTnI) concentration was measured before, four hours and the next day after stress test. Primary endpoint included hscTnI concentration above 99th percentile of the upper reference limit in second or third measurement or new persistent ST-T segment changes. Secondary endpoints were: new persistent or transient ECG changes (ST-T segment elevation or depression or negative T waves, prolongation of QRS complex, PR interval or QTc), or any drug-related adverse event. 

Results. The concentrations of hscTnI were below 99th percentile of the upper limit among all the patients. Primary and secondary endpoint were observed in 6 (24%) and 23 (92%) patients, respectively. Transient ST-T segment elevation occurred in 4 (16%) patients, transient ST-T segment depression or negative T wave — in 7 (25%) patients, QRS complex prolongation — in 11 (44%) patients, PR interval prolongation — in 18 (75%) patients, QTc prolongation — in 22 (88%) patients, any clinical adverse event related to dipyridamole — in 16 (64%) patients. Following endpoints were correlated with positive MPS results: ST-T segment changes, RP interval prolongation, and with a history of chest pain: ST-T seg- ment changes, QRS complex and QTc prolongation. 

Conclusions. MPS with dipyridamole stress is relatively safe, as hscTnI concentration remains within normal in prolon- ged observation after the examination. While there is a significant risk of minor clinical and electrocardiographic adverse events it is not related with a myocardial necrosis. 

Abstract

Introduction. Myocardial perfusion scintigraphy (MPS) with dipyridamole is an accepted method for assessment of is- chaemic heart disease, in case of contraindication to exercise testing. However, very often we observe clinical symptoms and changes in ECG while monitoring patients during the study with pharmacologic stress with dipyridamole. The aim of this study was to investigate the safety of patients diagnosed with MPS with dipyridamole. 

Material and methods. Twenty-five patients with stable coronary artery disease participated in a 2-day protocol (0.56 mg/ kg dipyridamole i.v. and then rest) using Tc-MIBI imaging. Continuous clinical monitoring and 12-lead serial ECG has been used since the beginning of the MPS up to 20 minutes after the examination. High-sensitive cardiac troponin I (hscTnI) concentration was measured before, four hours and the next day after stress test. Primary endpoint included hscTnI concentration above 99th percentile of the upper reference limit in second or third measurement or new persistent ST-T segment changes. Secondary endpoints were: new persistent or transient ECG changes (ST-T segment elevation or depression or negative T waves, prolongation of QRS complex, PR interval or QTc), or any drug-related adverse event. 

Results. The concentrations of hscTnI were below 99th percentile of the upper limit among all the patients. Primary and secondary endpoint were observed in 6 (24%) and 23 (92%) patients, respectively. Transient ST-T segment elevation occurred in 4 (16%) patients, transient ST-T segment depression or negative T wave — in 7 (25%) patients, QRS complex prolongation — in 11 (44%) patients, PR interval prolongation — in 18 (75%) patients, QTc prolongation — in 22 (88%) patients, any clinical adverse event related to dipyridamole — in 16 (64%) patients. Following endpoints were correlated with positive MPS results: ST-T segment changes, RP interval prolongation, and with a history of chest pain: ST-T seg- ment changes, QRS complex and QTc prolongation. 

Conclusions. MPS with dipyridamole stress is relatively safe, as hscTnI concentration remains within normal in prolon- ged observation after the examination. While there is a significant risk of minor clinical and electrocardiographic adverse events it is not related with a myocardial necrosis. 

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Keywords

myocardial perfusion scintigraphy; ischaemic heart disease; dipyridamole; safety

About this article
Title

Safety of patients diagnosed with myocardial perfusion scintigraphy with dipyridamole stress — drawing the issue to the attention

Journal

Folia Cardiologica

Issue

Vol 14, No 1 (2019)

Pages

13-18

Published online

2019-04-10

DOI

10.5603/FC.2019.0006

Bibliographic record

Folia Cardiologica 2019;14(1):13-18.

Keywords

myocardial perfusion scintigraphy
ischaemic heart disease
dipyridamole
safety

Authors

Marek Cacko
Ryszard Tomasiuk
Andrzej Cacko
Monika Gawałko
Gabriela Parol
Michał Nieciecki
Leszek Królicki

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