title: Comparison of arbutamine stress 99mTc-labeled sestamibi single-photon emission computed tomographic imaging and echocardiography for detection of the extent and severity of coronary artery disease and inducible ischemia.
abstract: BACKGROUND
  Arbutamine is a new synthetic catecholamine developed specifically for pharmacologic stress testing.
  
  
  RESULTS
  We investigated 39 patients undergoing coronary arteriography to compare arbutamine stress (99m)Tc-labeled sestamibi single-photon emission computed tomographic imaging and echocardiography for detection of the extent and severity of coronary artery disease and inducible ischemia. Rest and stress studies were analyzed blindly according to a 12-segment left ventricular model for both techniques. Each segment was graded according to severity of wall thickening abnormality and perfusion defect (1 = normal to 4 = severe). Total perfusion defect and wall thickening scores were calculated at peak stress and the difference in scores between stress and rest (delta perfusion defect; delta wall thickening) were used as indexes of inducible ischemia. Twenty-one patients had multivessel disease, nine had single-vessel disease, and nine had normal coronary arteries. Diagnostic accuracies for the detection of coronary artery disease for single-photon emission computed tomographic imaging and echocardiography were 95% and 92%, respectively. Extent and severity of coronary artery disease indicated by a peak stress perfusion defect score of 26 +/- 6.4 and wall thickening score of 25.1 +/- 8.4 were similar, and there was no significant difference in the delta perfusion defect and delta wall thickening scores of 8.7 +/- 5.5 and 10.4 +/- 7.1, respectively. Segmental concordance rates for the detection of coronary artery disease and inducible ischemia were 74% (K = 0.47; confidence interval 0.39 to 0.55) and 74% (kappa = 0.42; confidence interval 0.34 to 0.51), respectively. Regional concordance for coronary artery disease was 84% (kappa = 0.68; confidence interval 0.51 to 0.84). Where discordance was present, there was a greater prevalence of perfusion abnormality compared with wall thickening abnormality.
  
  
  CONCLUSIONS
  Arbutamine stress single-photon emission computed tomographic imaging and echocardiography provide largely equivalent and accurate pathophysiologic information for the evaluation of coronary artery disease and inducible ischemia.
authors.affiliation: Northwick Park and St Mark's Hospitals National Health Service (NHS) Trust and the Institute of Medical Research, Harrow, Middlesex, United Kingdom.
authors.forename: R S
authors.initials: RS
authors.lastname: Khattar
authors.forename: R
authors.initials: R
authors.lastname: Senior
authors.forename: D
authors.initials: D
authors.lastname: Joseph
authors.forename: A
authors.initials: A
authors.lastname: Lahiri
mesh_terms: D002316:Cardiotonic Agents; D002395:Catecholamines; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002316:Cardiotonic Agents; D002395:Catecholamines; D017256:Technetium Tc 99m Sestamibi; C076559:arbutamine