Reversibility by dipyridamole of thallium-201 myocardial scan defects in patients with sarcoidosis

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Purpose

In order to clarify the significance of anginal pain and myocardial thallium-201 scan defects in cardiac sarcoidosis, the pharmacologic effect of dipyridamole on myocardial perfusion was assessed by planar thallium-201 myocardial scintigraphy in patients with sarcoidosis.

Patients and methods

Thallium-201 myocard al scintigraphy was performed at rest and after 0.56 rag/kg intravenous dipyridamole during four minutes in 16 patients with sarcoidosis. The myocardial scan (45-degree and 70-degree left anterior oblique, and anterior views) was divided into 15 segments. Results were evaluated by the number of segmental defects and with a global perfusion score (from 0 to 60) by a semi-quantitative index depending on the size and the severity of myocardial thallium-201 defects.

Results

Thirteen of the 16 patients showed partial or total reversion of their thallium-201 defects on redistribution scanning either at rest or after dipyridamole. The mean (± SD) number of myocardial perfusion defects that were present in all the patients decreased from 5.31 ± 1.78 at rest to 3.25 ± 2.52 after redistribution (p < 0.001) and to 2.19 ± 2.10 after dipyridamole (p < 0.001). The mean global perfusion score increased from 53.2 ± 3.0 at rest to 56.2 ± 2.9 after redistribution (p <0.001) and to 57.2 ± 2.7 after dipyridamole (p <0.001). A signiflcant correlation (r = 0.82, p < 0.001) was found between the increase of global perfusion score on redistribution and after dipyridamole.

Conclusion

The reversibility of myocardial scan defects is a common finding in sarcoidosis. It makes unlikely the role of scar fibrosis or extensive confluent granulomas as a mechanism for such defects. The effect of dipyridamole suggests the presence of reversible disorders lying at the coronary microvascular level.

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