Usefulness of oral dipyridamole suspension for stress thallium imaging without exercise in the detection of coronary artery disease.
Usefulness of oral dipyridamole suspension for stress thallium imaging without exercise in the detection of coronary artery disease.
复制标题
口服双嘧达莫混悬液在不运动的情况下进行应激铊成像在检测冠状动脉疾病中的作用。
DOI：
10.1016/0002-9149(86)90824-6
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Boucher,CA
中科院分区：
文献类型：
--
作者：
Homma,S;Callahan,RJ;Ameer,B;McKusick,KA;Strauss,HW;Okada,RD;Boucher,CA
使用静脉注射双嘧达莫进行应力铊成像无需运动即可评估冠状动脉疾病 (CAD)。然而，静脉注射双嘧达莫在美国仅处于实验阶段。为了研究口服双嘧达莫作为静脉注射双嘧达莫的临床可用替代品的用途，100 名患者接受了口服双嘧达莫的铊成像。每位患者服用 300 毫克粉末状片剂，溶于 30 毫升悬浮液中。摄入后 30 分钟，平均心率最大增加，平均血压最大降低。 45 分钟时，静脉注射 2 mCi 铊，并在 7 分钟内开始连续成像。口服300mg后45分钟的血清双嘧达莫水平（平均值±标准差）（3.7±2.2μg/ml）与静脉内给予0.56mg/kg后5分钟（4.6±1.3μg/ml）相似。 55 名患者在口服后 15 至 75 分钟内出现一些不良反应，包括恶心、头痛、头晕、胸痛（25 名患者）和心电图改变（14 名患者）。 21 名患者使用静脉注射氨茶碱来解决这些不良反应。没有发生严重心律失常、心肌梗塞或死亡。在 43 名经血管造影记录的 CAD 患者中，39 名患者存在初始灌注缺陷，该缺陷在延迟图像上重新分布。当按各个节段分析接受导管插入术的患者的结果时，铊重新分布的存在与该节段左心室造影左心室壁运动正常或运动减退相关，而持续缺陷的存在与运动不能或运动障碍相关（Fisher 标准化 Z = 9.14）。总之，使用临床上可用的双嘧达莫形式（口服混悬液），无需运动即可进行应力铊成像。它是安全的，可用于评估 CAD，以揭示低灌注的存活心肌区域。
Stress thallium imaging with intravenous dipyridamole permits assessment of coronary artery disease (CAD) without the need for exercise. However, intravenous dipyridamole is available in the United States only on an experimental basis. To study the use of oral dipyridamole as a clinically available alternative to intravenous dipyridamole for this purpose, 100 patients underwent thallium imaging with oral dipyridamole. Each patient received 300 mg of pulverized tablets in a 30-ml suspension. Maximal increase in mean heart rate and decrease in mean blood pressure occurred 30 minutes after ingestion. At 45 minutes, 2 mCi of thallium was given intravenously and serial imaging was begun within 7 minutes. The serum dipyridamole level (mean ± standard deviation) 45 minutes after 300 mg was administered orally (3.7 ± 2.2 μg/ml) was similar to that 5 minutes after 0.56 mg/kg was given intravenously (4.6 ± 1.3 μg/ml). Fifty-five patients had some adverse effects between 15 and 75 minutes after oral ingestion, including nausea, headache, dizziness, chest pain (25 patients) and electrocardiographic changes (14 patients). Intravenous aminophylline was used to resolve these adverse effects in 21 patients. There were no severe arrhythmias, myocardial infarctions or deaths. Of the 43 patients with angiographically documented CAD, 39 had an initial perfusion defect that redistributed on the delayed images. When the results in patients who had undergone catheterization were analyzed by individual segment, the presence of thallium redistribution was associated with normal or hypokinetic contrast left ventriculographic wall motion of that segment, whereas the presence of a persistent defect was associated with akinesia or dyskinesia (Fisher's standardized Z = 9.14). In conclusion, stress thallium imaging without exercise is feasible with a clinically available form of dipyridamole—the oral suspension. It is safe and may be used for evaluation of CAD to unmask regions of hypoperfused viable myocardium.