Valor diagnóstico da ecocardiografia com dipiridamol em doença coronária e avaliação de sua potencialidade prognóstica frente à ergometria, cintigrafia de perfusão miocárdica planar com dipiridamol e Tc99m-MIBI e cinecoronariografia / Diagnostic value of dipyridamole echocardiography in coronary artery disease and comparison of its prognostic accuracy with that of exercise stress test, planar dipyridamole Tc99m-MIBI myocardial perfusion scintigraphy and coronary rteriography

PURPOSE--To assess in a consecutive series of patients, the diagnostic accuracy of dipyridamole echocardiography and to compare its prognostic power with that from other tests. METHODS--Seventy eight patients prospectively were underwent to dipyridamole echocardiography (DET) and coronary arteriography for diagnostic and post-infarction investigation. The majority was underwent to treadmill stress test and Tc99MIBI-dipyridamole planar myocardial scintigraphy. Eleven variables with possible prognostic importance were analyzed in a stepwise model to identify independent predictors of events. RESULTS--Sensitivity and specificity for the presence of coronary artery disease (in non-M patients) and multivessel disease (in post-MI patients) were, respectively, 44, 91, 53 and 88. Mean follow-up was 21 +/- 9 months, during which there were four deaths, four unstable angina episodes, four nonfatal myocardial infarctions and eight revascularization procedures. By multivariate analysis, the only independent predictor of events was the change in wall motion score index from rest to peak stress. CONCLUSION--DET is a valuable alternative to exercise stress test and myocardial perfusion scintigraphy. Semiquantitative estimation of ischemic area during pharmacological stress is an important prognostic marker.

Comparaçäo clínica entre indoramina e propranolol: estudo comparativo da funçäo cardíaca avaliada por técnicas näo-invasivas / Clinical comparison between indoramin and propranolol: comparative study of the heart function evaluated by non-invasive methods

Estudou-se a açäo hipotensora da indoramina, comparando-a com a de um agente beta-bloqueador, o propranolol. A freqüência cardíaca e as alteraçöes dos intervalos sistólicos foram observadas notando-se, em relaçäo ao alfa-bloqueador, uma discreta queda da freqüência cardíaca e um pequeno aumento da fraçäo de ejeçäo, efeitos diferentes daqueles teoricamente esperados, isto é um aumento da freqüência, por reflexo adrenérgico, e um maior aumento da fraçäo de ejeçäo, pela diminuiçäo da pós-carga, resultado do efeito hipotensor comprovado para a droga. Assim, aventamos a hipótese de que a indoramina impede a resposta hemodinâmica esperada, por uma açäo primária cárdio-inibidora