The role of dipyridamole-exercise echocardiography test for diagnosis of coronary artery disease. Future challenges and prospects

Abstract

Background: Coronary artery disease (CAD) is the third leading cause of mortality worldwide and the first cause of death in the Spanish state (1). It has been well documented that exercise stress test using electrocardiographic and echocardiographic markers of ischemia, most of the time, allows the non-invasive detection of CAD (2). Even so, a significant proportion of patients with a history of chest pain are still unclassified, without an objective diagnosis of ischemia, with all the consequences that this entails. In this patient population, the use of a combined stress (physiological with exercise plus pharmacological with dipyridamole) could provide greater sensitivity for the diagnosis of CAD. Dipyridamole can reduce myocardial oxygen supply through flow maldistribution and increased dynamic stenosis (3). On the other hand, exercise increases myocardial oxygen demand considerably, but it can simultaneously cause an increase in dynamic stenosis (4). The theory is that the two types of stress could act synergistically to cause an imbalance between myocardial oxygen demand and supply.

Objective: The purpose of this study is to evaluate whether dipyridamole infusion to exercise stress echocardiography allows the identification of a significant proportion of patients with CAD, where exercise-only echocardiography is inconclusive. Design: A cross-sectional study in the cardiac imaging unit of the Hospital Universitari de Girona Doctor Josep Trueta. Methods: patients who have undergone exercise stress echocardiography, on suspicion of CAD and inconclusive result, will perform the same test again but adding dipyridamole, with the aim of diagnosing a significant proportion of patients with CAD. This cross-sectional study will be carried out in 1 and a half year in Girona