Detection of coronary artery disease: comparison between technetium 99m-labeled sestamibi single-photon emission computed tomography and two-dimensional echocardiography with dipyridamole low-level exercise-stress.
BACKGROUND
Myocardial perfusion imaging in conjunction with dipyridamole low-level exercise stress has proved its value in the evaluation of patients with coronary artery disease (CAD). Simultaneous wall motion analysis by two-dimensional (2D) echocardiography may provide additional information beyond that obtained by myocardial perfusion imaging alone. The purpose of this study was to compare 99mTc-labeled sestamibi single-photon emission computed tomography (SPECT) and 2D echocardiography for the evaluation of CAD according to a dipyridamole low-level bicycle exercise stress protocol.


RESULTS
We studied 35 consecutive patients referred for the evaluation of chest pain who had undergone coronary arteriography. 99mTc-labeled sestamibi SPECT and 2D echocardiography agreed in 27 patients (80%) studied for overall detection of CAD. On a segmental basis, agreement was found between SPECT and 2D echocardiography in 124 (73%) of 170 segments (Cohen's kappa = 0.43). The accuracy of the combined assessment of myocardial perfusion and echocardiographic wall motion in detecting CAD was 86%, which was not different from the accuracy of SPECT alone (80%; difference not significant) but significantly higher than for 2D echocardiography alone (71%; p = 0.03). In the detection of individual coronary artery stenoses, SPECT had a significantly higher accuracy for detecting left anterior descending coronary artery lesions than had 2D echocardiography (80% vs 60%; p < 0.01); combining the two method did not improve the accuracy (80%). The combined assessment slightly improved the accuracy for detecting left circumflex coronary artery stenoses from 71% to 83% (p = 0.05).


CONCLUSIONS
The combined simultaneous assessment of myocardial perfusion by 99mTc-labeled sestamibi SPECT and wall motion by 2D echocardiography did not significantly improve overall accuracy over that obtained by 99mTc-labeled sestamibi SPECT alone. Therefore 99mTc-labeled sestamibi SPECT with dipyridamole low-level exercise stress appears the preferred imaging modality for the evaluation of patients with CAD.
Cramer
M J
MJ
Department of Cardiology, St. Antonius Hospital, Niewegein, The Netherlands.
van der Wall
E E
EE
Jaarsma
W
W
Verzijlbergen
J F
JF
Niemeyer
M G
MG
Zwinderman
A H
AH
Pauwels
E K
EK
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004176:Dipyridamole; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents; D016276:Ventricular Function
D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi