Comparison of coronary vasodilation with intravenous dipyridamole and adenosine

Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242.

Although both intravenous dipyridamole and adenosine have been used to produce coronary vasodilation during cardiac imaging, the relative potency of the commonly administered doses of these agents has not been evaluated. Accordingly, the coronary and systemic hemodynamic effects of intravenous adenosine (140 micrograms/kg per min) and intravenous dipyridamole (0.56 mg/kg over 4 min) were compared with a maximally dilating dose of intracoronary papaverine in 15 patients. Coronary blood flow responses were assessed using a Doppler catheter in a nonstenotic coronary artery. The protocol was discontinued in two patients because of transient asymptomatic atrioventricular (AV) block during adenosine infusion. The mean heart rate increased more with adenosine (11 +/- 9 beats/min) and dipyridamole (11 +/- 7 beats/min) than with papaverine (4 +/- 3 beats/min, p less than 0.05 vs. adenosine and papaverine). The mean arterial pressure decreased less with dipyridamole (-10 +/- 3 mm Hg) and papaverine (-9 +/- 4 mm Hg) than with adenosine (-16 +/- 5 mm Hg, p less than 0.01 vs. dipyridamole and papaverine). The peak/rest coronary blood flow velocity ratio was greater with papaverine (3.9 +/- 1.1) than with adenosine (3.4 +/- 1.2, p less than or equal to 0.05 vs. papaverine) or dipyridamole (3.1 +/- 1.2, p less than 0.01 vs. papaverine). A larger decrease in coronary resistance as measured by the coronary vascular resistance index occurred with papaverine (0.25 +/- 0.06) and adenosine (0.26 +/- 0.09) than with dipyridamole (0.31 +/- 0.10, p less than 0.01 vs. papaverine, p less than 0.05 vs. adenosine).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				P. K. Nair, O. C. Marroquin, S. R. Mulukutla, S. Khandhar, V. Gulati, J. T. Schindler, and J. S. Lee Clinical Utility of Regadenoson for Assessing Fractional Flow Reserve J. Am. Coll. Cardiol. Intv., October 1, 2011; 4(10): 1085 - 1092. [Abstract] [Full Text] [PDF]

				H. Gewirtz Quantitative PET Measurements of Myocardial Blood Flow in Young, Healthy Volunteers: What Should We Expect? J. Am. Coll. Cardiol. Img., April 1, 2011; 4(4): 413 - 415. [Full Text] [PDF]

				I. Klem, J. F. Heitner, D. J. Shah, M. H. Sketch Jr, V. Behar, J. Weinsaft, P. Cawley, M. Parker, M. Elliott, R. M. Judd, et al. Improved Detection of Coronary Artery Disease by Stress Perfusion Cardiovascular Magnetic Resonance With the Use of Delayed Enhancement Infarction Imaging J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1630 - 1638. [Abstract] [Full Text] [PDF]

				P. A. Kaufmann, M. Namdar, F. Matthew, M. Roffi, S. V. Aschkenasy, B. van der Loo, G. Sutsch, T. F. Luscher, and R. Jenni Novel Doppler Assessment of Intracoronary Volumetric Flow Reserve: Validation Against PET in Patients With or Without Flow-Dependent Vasodilation J. Nucl. Med., August 1, 2005; 46(8): 1272 - 1277. [Abstract] [Full Text] [PDF]

				M. Vanderheyden, J. Bartunek, S. Verstreken, L. Mortier, M. Goethals, and B. de Bruyne Non-invasive assessment of coronary flow reserve in idiopathic dilated cardiomyopathy: hemodynamic correlations Eur Heart J Cardiovasc Imaging, January 1, 2005; 6(1): 47 - 53. [Abstract] [Full Text] [PDF]

				S. Kubo, E. Tadamura, H. Toyoda, M. Mamede, M. Yamamuro, Y. Magata, T. Mukai, H. Kitano, N. Tamaki, and J. Konishi Effect of Caffeine Intake on Myocardial Hyperemic Flow Induced by Adenosine Triphosphate and Dipyridamole J. Nucl. Med., May 1, 2004; 45(5): 730 - 738. [Abstract] [Full Text] [PDF]

				J. E. Udelson, G. V. Heller, F. J.Th. Wackers, A. Chai, D. Hinchman, P. S. Coleman, V. Dilsizian, M. DiCarli, R. Hachamovitch, J. R. Johnson, et al. Randomized, Controlled Dose-Ranging Study of the Selective Adenosine A2A Receptor Agonist Binodenoson for Pharmacological Stress as an Adjunct to Myocardial Perfusion Imaging Circulation, February 3, 2004; 109(4): 457 - 464. [Abstract] [Full Text] [PDF]

				A. M. Meyers, L. Topham, J. Ballow, D. Totah, and R. Wilke Adverse Reactions to Dipyridamole in Patients Undergoing Stress/Rest Cardiac Perfusion Testing J. Nucl. Med. Technol., March 1, 2002; 30(1): 21 - 24. [Abstract] [Full Text] [PDF]

				R. Scognamiglio, A. Avogaro, S. Vigili de Kreutzenberg, C. Negut, M. Palisi, E. Bagolin, and A. Tiengo Effects of Treatment With Sulfonylurea Drugs or Insulin on Ischemia-Induced Myocardial Dysfunction in Type 2 Diabetes Diabetes, March 1, 2002; 51(3): 808 - 812. [Abstract] [Full Text] [PDF]

				R. Jenni, C. A. Wyss, E. N. Oechslin, and P. A. Kaufmann Isolated ventricular noncompaction is associated with coronary microcirculatory dysfunction J. Am. Coll. Cardiol., February 6, 2002; 39(3): 450 - 454. [Abstract] [Full Text] [PDF]

				M. Billinger, C. Seiler, M. Fleisch, F. R. Eberli, B. Meier, and O. M. Hess Do beta-adrenergic blocking agents increase coronary flow reserve? J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1866 - 1871. [Abstract] [Full Text] [PDF]

				E. Tadamura, H. Iida, K. Matsumoto, M. Mamede, S. Kubo, H. Toyoda, T. Shiozaki, T. Mukai, Y. Magata, and J. Konishi Comparison of myocardial blood flow during dobutamine-atropine infusion with that after dipyridamole administration in normal men J. Am. Coll. Cardiol., January 1, 2001; 37(1): 130 - 136. [Abstract] [Full Text] [PDF]

				J.-P. Bin, R. A. Pelberg, K. Wei, M. Coggins, N. C. Goodman, and S. Kaul Relation between regional function and coronary blood flow reserve in multivessel coronary artery stenosis Am J Physiol Heart Circ Physiol, December 1, 2000; 279(6): H3058 - H3064. [Abstract] [Full Text] [PDF]

				P. A. Kaufmann and R. Jenni Coronary flow reserve assessment from average peak velocity profiles alone must be judged with caution J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1363 - 1364. [Full Text] [PDF]

				R. Jenni, A. Linka, M. Barton, C. Caiati, C. Montaldo, N. Zedda, A. Bina, and S. Iliceto Assessment of Coronary Flow Reserve by Contrast-Enhanced Second Harmonic Echo Doppler Response Circulation, March 14, 2000; 101(10): e100 - e100. [Full Text] [PDF]

				C. Caiati, C. Montaldo, N. Zedda, R. Montisci, M. Ruscazio, G. Lai, M. Cadeddu, L. Meloni, and S. Iliceto Validation of a new noninvasive method (contrast-enhanced transthoracic second harmonic echo Doppler) for the evaluation of coronary flow reserve: Comparison with intracoronary Doppler flow wire J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1193 - 1200. [Abstract] [Full Text] [PDF]

				C. Caiati, N. Zedda, C. Montaldo, R. Montisci, and S. Iliceto Contrast-enhanced transthoracic second harmonic echo doppler with adenosine: A noninvasive, rapid and effective method for coronary flow reserve assessment J. Am. Coll. Cardiol., July 1, 1999; 34(1): 122 - 130. [Abstract] [Full Text] [PDF]

				N. Kawada, H. Sakuma, T. Yamakado, K. Takeda, N. Isaka, T. Nakano, and C. B. Higgins Hypertrophic Cardiomyopathy: MR Measurement of Coronary Blood Flow and Vasodilator Flow Reserve in Patients and Healthy Subjects Radiology, April 1, 1999; 211(1): 129 - 135. [Abstract] [Full Text]

				C. Caiati, C. Montaldo, N. Zedda, A. Bina, and S. Iliceto New Noninvasive Method for Coronary Flow Reserve Assessment : Contrast-Enhanced Transthoracic Second Harmonic Echo Doppler Circulation, February 16, 1999; 99(6): 771 - 778. [Abstract] [Full Text] [PDF]

				T. Hozumi, K. Yoshida, T. Akasaka, Y. Asami, Y. Ogata, T. Takagi, S. Kaji, T. Kawamoto, Y. Ueda, and S. Morioka Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: Comparison with invasive technique J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1251 - 1259. [Abstract] [Full Text] [PDF]

				T. Hozumi, K. Yoshida, Y. Ogata, T. Akasaka, Y. Asami, T. Takagi, and S. Morioka Noninvasive Assessment of Significant Left Anterior Descending Coronary Artery Stenosis by Coronary Flow Velocity Reserve With Transthoracic Color Doppler Echocardiography Circulation, April 28, 1998; 97(16): 1557 - 1562. [Abstract] [Full Text] [PDF]

				W. Motz and B. E. Strauer Improvement of Coronary Flow Reserve After Long-term Therapy With Enalapril Hypertension, May 1, 1996; 27(5): 1031 - 1038. [Abstract] [Full Text]

				E. A. Caracciolo, T. L. Wolford, R. D. Underwood, T. J. Donohue, R. G. Bach, L. W. Miller, and M. J. Kern Influence of Intimal Thickening on Coronary Blood Flow Responses in Orthotopic Heart Transplant Recipients : A Combined Intravascular Doppler and Ultrasound Imaging Study Circulation, November 1, 1995; 92(9): 182 - 190. [Abstract] [Full Text]

				A. Nussbacher, S. Arie, R. Kalil, P. Horta, M. D. Feldman, G. Bellotti, F. Pileggi, M. Ellis, W. H. Johnson, G. B. Camarano, et al. Mechanism of Adenosine-Induced Elevation of Pulmonary Capillary Wedge Pressure in Humans Circulation, August 1, 1995; 92(3): 371 - 379. [Abstract] [Full Text]

				R. F. Redberg, Y. Sobol, T. M. Chou, M. Malloy, S. Kumar, E. Botvinick, and J. Kane Adenosine-Induced Coronary Vasodilatation During Transesophageal Doppler Echocardiography : Rapid and Safe Measurement of Coronary Flow Reserve Ratio Can Predict Significant Left Anterior Descending Coronary Stenosis Circulation, July 15, 1995; 92(2): 190 - 196. [Abstract] [Full Text]

				W. Motz, S. Scheler, B. Schwartzkopff, and B. E. Strauer Evaluation of Cardiac Damage in Hypertension European Journal of Cardiovascular Prevention & Rehabilitation, February 1, 1995; 2(1): 16 - 26. [Abstract] [PDF]

				D. K. Glover, M. Ruiz, N. C. Edwards, M. Cunningham, J. P. Simanis, W. H. Smith, D. D. Watson, and G. A. Beller Comparison Between 201Tl and 99mTc Sestamibi Uptake During Adenosine-Induced Vasodilation as a Function of Coronary Stenosis Severity Circulation, February 1, 1995; 91(3): 813 - 820. [Abstract] [Full Text]