Simultaneous dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography in patients with suspected coronary artery disease

AbstractObjectives. The purpose of this study was to determine the relative value of dobutamine stress echocardiography and technetium-99m isonitrite single-photon emission computed tomography (mibi SPECT) in the detection of myocardial ischemia.Background. Stress-induced new wall motion abnormalities and transient perfusion defects are both used for the diagnosis of myocardial ischemia.Methods. One hundred five consecutive patients with either proved or suspected coronary artery disease, who were referred for perfusion scintigraphy, were studied by a combination of the two techniques. Both echocardiographic and mibi SPECT images were visually analyzed. Three patients were excluded from the final analysis because of unsatisfactory examinations: two with noninterpretable stress echocardiograms and one with noninterpretable mibi SPECT images. The response to stress was concordantly classified by both techniques in 68% of patients (kappa = 0.51).Results. Dobutamine stress echocardiography revealed the presence of ischemia in 38 and mibi SPECT in 45 patients (overall agreement = 74%, kappa = 0.46). The agreement was higher in patients without previous myocardial infarction (84%, kappa = 0.62). When regional analysis was performed, concordance of stress echocardiography and mibi SPECT occurred in 84% of the 306 regions (kappa = 0.45). Regional agreement was also slightly higher in patients without previous infarction (88%, kappa = 0.50). In 21 patients without previous myocardial infarction who underwent coronary angiography, the overall sensitivity of dobufamine stress echocardiography and mibi SPECT for the diagnosis of coronary artery disease (diameter stenosis >50%) was 75% and 83%, respectively, with a specificity of 89% (eight of nine patients) for both tests.Conclusions. Dobutamine stress echocardiography represents a reasonable alternative to dobutamine mibi SPECT for the functional assessment of patients with suspected myocardial ischemia and without previous myocardial infarction

Prognostic value of dobutamine-atropine stress technetium-99m sestamibi perfusion scintigraphy in patients with chest pain

Objectives.This study investigated the prognostic value of dobutamine-atropine technetium-99m (Tc-99m) sestamibi singlephoton emission computed tomographic (SPECT) myocardial perfusion imaging.Background.Dobutamine-atropine Tc-99m sestamibi SPECT imaging is an accurate method for the detection of coronary disease. However, the prognostic value of this stress modality has not been assessed.Methods.Three hundred ninety-two consecutive patients with chest pain (mean [±SD] age 60 ± 12 years; 220 men, 190 with a previous myocardial infarction) underwent a dobutamineatropine Tc-99m sestamibi SPECT scintigraphic study. Patients were followed up for 22 ± 13 months to determine the univariate and multivariate variables associated with hard cardiac events (cardiac death, nonfatal myocardial infarction), to define their event-free survival and to determine whether the extent and severity of reversible perfusion defects correlated with events.Results.Forty-four patients (11%) had hard cardiac events. Multivariate models demonstrated that older age (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0 to 4.4), history of heart failure (OR 2.6, 95% CI 1.3 to 5.2), abnormal sestamibi scan results (OR 10.0, 95% CI 2.3 to 43.0) and reversible perfusion defects (OR 3.2, 95% CI 1.6 to 6.4) had independent predictive value. Patients without perfusion defects, with fixed defects alone, reversible defects alone and fixed plus reversible defects had annual hard cardiac event rates of 0.8%, 6.8%, 8.1% and 11.6%, respectively. Patients with increasing reversible defect scores had increasing annual event rates of 2.1%, 5.0%, 5.5%, 13.0% and 14.6%, respectively.Conclusions.Dobutamine-atropine stress Tc-99m sestamibi SPECT imaging provides excellent prognostic information. The single most important independent predictor for future hard cardiac events is an abnormal pattern, and a reversible defect provides additional, independent prognostic information. Moreover, the extent and severity of reversible defects are major determinants for prognosis