Development of nitrate tolerance evaluated by echo-dipyridamole stress test in patients with coronary artery disease

G. Longobardi, N. Ferrara, R. Rosiello, F. Giuliano, G. Furgi, V. Valente, V. Carnovale, A. Nicolino, F. Rengo

Research output: Contribution to journalArticlepeer-review

Abstract

The present study explores the acute and chronic effects of isosorbide-5-mononitrate (5-ISMN) 80 mg administration on dipyridamole-induced myocardial ischemia. Continuous administration of organic nitrates leads to a decrease in their therapeutic efficacy (nitrate tolerance). Exercise stress test used to recognize development of nitrate tolerance, presents many limitations. It is not known whether dipyridamole stress echocardiography is a useful test to assess the efficacy and nitrate tolerance. In 22 patients with stable myocardial ischemia we prospectively studied the acute and chronic effects of 5-ISMN 80 mg daily on dipyridamole-induced myocardial ischemia, the ability of dipyridamole stress echocardiography to evaluate development of nitrate tolerance. After acute treatment with 5-ISMN dipyridamole stress echocardiography was negative in 19 out of 22 patients (p <0.001 vs placebo). During the sustained phase, dipyridamole stress echocardiography returned positive after placebo in all 19 patients and after active drug in 18 (NS vs placebo). Our results indicate that acute administration of 5-ISMN antagonizes dipyridamole-induced myocardial ischemia and show the loss of antischemic efficacy in 95% of patients during sustained treatment, demonstrating that dipyridamole stress echocardiography is a useful tool to assess the presence of nitrate tolerance.

Original languageEnglish
Pages (from-to)111-114
Number of pages4
JournalCardiovascular Imaging
Volume11
Issue number3
Publication statusPublished - 1999

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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