PMC4008276_01
Scheme of "fast" protocol with dipyridamole for evaluating CFR and regional wall motion according to the recommendations of the European Association of Echocardiography.
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fig1
In December 2010, she underwent a pharmacologic stress echocardiography with dipyridamole (0.84 mg/Kg in 6 minutes, "fast" protocol) to evaluate at the same time the coronary flow reserve (CFR) and the regional wall motion according to the stress echo recommendations of the European Association of Echocardiography (Figure 1).
Surface ECG performed at the high-dose dipyridamole during stress echocardiography, showing a clear depression of the antero-septal ST segment. At the same time the patient referred angina pectoris.
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fig2
In the presence of angina pectoris and significant repolarization phase abnormalities of the surface ECG (Figure 2) the stress echo showed an impaired CFR (<2) (Figure 3) without regional wall motion alteration.
High-dose dipyridamole induced CFR during the same stress echocardiography of Figure 2.
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fig3
In the presence of angina pectoris and significant repolarization phase abnormalities of the surface ECG (Figure 2) the stress echo showed an impaired CFR (<2) (Figure 3) without regional wall motion alteration.
CFR evaluation after 6-month therapy with ranolazine.
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Again in the absence of regional wall motion abnormalities, the test showed a completely normal CFR with a relevant improvement in comparison with the previously performed test (from 1.85 to 4.00) (Figure 4).
Surface ECG performed at high-dose dipyridamole during stress echocardiography after 6-month therapy with ranolazine. At the same time the patient was completely asymptomatic.
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fig5
Of interest, the patient did not exhibit any kind of symptoms during and after the stress echo and the surface ECG was totally normal (Figure 5).