Hypertension, Vol 12, 238-243, Copyright © 1988 by American Heart Association
E Picano, AR Lucarini, F Lattanzi, A Distante, V Di Legge, A Salvetti and A L'Abbate
The exercise-electrocardiography test shows limited feasibility and
diagnostic accuracy for the noninvasive detection of coronary artery
disease in hypertensive patients. Recently, the dipyridamole-
echocardiography test (two-dimensional echocardiographic monitoring with
dipyridamole infusion, up to 0.84 mg/kg over 10 minutes) has been proposed
as an exercise-independent method for the diagnosis of coronary artery
disease. The diagnostic usefulness of the exercise- electrocardiography
test and the dipyridamole-echocardiography test was evaluated in 63
consecutive inpatients with history of chest pain, essential hypertension,
and no previous myocardial infarction. The criterion of positivity for the
exercise-electrocardiography test was a horizontal or downsloping ST
segment shift exceeding 0.1 mV and for the dipyridamole-echocardiography
test, a transient dyssynergy of contraction. Fifteen patients could not
perform a diagnostic exercise- electrocardiography test because of an
inability to exercise adequately (two patients), severe hypertension in
spite of full antihypertensive therapy (six patients), or excessive blood
pressure rise at the first step of the exercise-electrocardiography test
(seven patients). Five patients could not perform the
dipyridamole-echocardiography test because of a poor acoustic window. The
overall feasibility was 76% for the exercise-electrocardiography test and
92% for the dipyridamole- echocardiography test (p less than 0.05). All 43
patients who performed both tests underwent coronary angiography; 30 had
significant coronary artery disease (greater than 70% lumen reduction of at
least 1 major coronary vessel). Sensitivity was 67% for both the exercise-
electrocardiography test and the dipyridamole-echocardiography test (p =
NS); specificity was 46% for the exercise-electrocardiography test and 92%
for the dipyridamole-echocardiography test (p less than 0.05).(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Dipyridamole echocardiography in essential hypertensive patients with chest pain
Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche and Patologia Medica, Universita di Pisa, Italy.
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