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EXPERIMENTAL STUDY

Dobutamine versus dipyridamole for inducing reversible perfusion defects in chronic multivessel coronary artery stenosis

^* Cardiovascular Imaging Center, the Cardiovascular Division, University of Virginia, Charlottesville, Virginia, USA

Manuscript received January 4, 2002; revised manuscript received March 4, 2002, accepted March 14, 2002.

^* Reprint requests and correspondence: Dr. Sanjiv Kaul, Cardiovascular Division, University of Virginia Medical Center, Box 800158, Charlottesville, Virginia 22908, USA.
sk{at}virginia.edu

OBJECTIVES: We hypothesized that, although the effects of dipyridamole and dobutamine on myocardial blood volume (MBV) and mean microbubble velocity (VEL) are different, the magnitude of perfusion deficit during both forms of stress is the same because both drugs unmask abnormal myocardial blood flow (MBF) reserve.

BACKGROUND: Both dipyridamole and dobutamine are used clinically as pharmacologic stress agents to induce reversible perfusion defects in patients with chronic coronary artery disease (CAD), but the basis for doing so for dobutamine is not clear.

METHODS: Eleven chronically instrumented closed-chest dogs with multivessel coronary stenosis were studied. Hemodynamics, radiolabeled microsphere-derived MBF, and myocardial contrast echocardiography (MCE)-derived myocardial perfusion were measured at rest, after dipyridamole infusion (0.56 mg·kg^–1), and at peak dobutamine dose (either 30 or 40 µg·kg^–1·min^–1). Abnormal beds were defined as those demonstrating an MBF reserve <3 with dipyridamole.

RESULTS: In the presence of either drug, MBV increased more in the normal bed than in the abnormal bed, but the increase was higher in both beds with dobutamine than with dipyridamole. The slope of the relationship between MBF reserve and MBV reserve was greater during dobutamine than dipyridamole (p < 0.05). The converse was true for VEL reserve (p < 0.05). Consequently, the relationship between the ratios of either variable, or the product of the two, between the abnormal bed and normal bed was similar for both drugs.

CONCLUSIONS: Although the effects of dipyridamole and dobutamine on MBV and VEL are different, both are equally effective in detecting physiologically relevant coronary stenoses on MCE. Both can therefore be used interchangeably with myocardial perfusion imaging for the detection of CAD.

Abbreviations and Acronyms   LAD   left anterior descending coronary artery   LCx   left circumflex coronary artery   LV   left ventricular   MBF   myocardial blood flow   MBV   myocardial blood volume   MCE   myocardial contrast echocardiography   PI   pulsing interval   RM   radiolabeled microsphere   VEL   myocardial microbubble velocity   VI   myocardial video intensity

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