Author + information
- Received July 7, 1992
- Revision received November 4, 1992
- Accepted December 7, 1992
- Published online June 1, 1993.
- Tamas Forster, MDa,b,1,
- Albert J. McNeill, MDa,b,2,
- Alessandro Salustri, MDa,b,5,
- Ambroos E.M. Reijs, MSca,b,3,
- El-Said M. El-Said, MB, BCh, MSa,b,4,
- Jos R.T.C. Roelandt, MD, FACCa,b,1 and
- Paolo M. Fioretti, MD, PhDa,b,∗
- ↵∗Address for correspondence: Paolo M. Fioretti, MD, Thoraxcenter, Ba 300, Erasmus University, P.O. Box 1738,3000 DR Rotterdam, The Netherlands.
Objectives. 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.
↵1 Dr. Forster is a recipient of the Research Fellowship of the European Society of Cardiology.
↵2 Dr. McNeill is a British Heart Foundation British-Dutch Research Fellow.
↵5 Dr. Regs is supported by Grant 87079 of the Dutch Heart Foundation, den Haag.
↵3 Dr. El-Said is supported by Et-Azhar University, Cairo, Egypt.
↵4 Dr. Salustri is supported by the Inteniniversity Cardiology Institute of the Netherlands.
☆ This study was prepared with the technical assistance of Wim B. Vtetter, BS.
- Received July 7, 1992.
- Revision received November 4, 1992.
- Accepted December 7, 1992.