Clinical Investigations Usefulness of Dipyridamole-Handgrip Radionuclide Ventriculography Test For Detecting Coronary Artery Disease

To assess the efficacy of IV dipyridamole (DP) combined with isometric handgrip exercise (IHE) inducting ischemia detectable by radionuclide ventriculography (RV2), we used both tests to study 11 normal subjects and 36 patients with coronary artery disease (CAD). RVg was performed at rest, after IV Dp (0.56 mg/kg) and during IHE. The mean increases in ejection fraction (EF) in the normal subjects after Dp and during IHE were significantly more than than of patients with CAD (6.6±2.6 % versus 2.6±4.0 %, p<0.001; and 5.6±1.9 % versus - 0.4±4.3 %, p<0.001). Considering an increase of less than 5 % in EF an abnormal response, the sensitivity and specificity of Dp alone were found to be 72 % 73 %, respectively. Combining IHE with Dp increased sensitivity to 83 % without a loss in specificity. Five patients (14 %) with CAD showed new wall motion abnormalities after Dp and 12 patients (33 %) after IHE, while no new wall motion abnormality was demonstrated in normal subjects. It is concluded that IHE during RVg for the detection of CAD can be conveniently combined with Dp, because it increases the sensitivity of the test compared to Dp alone without any loss in specificity.