title: High dose dipyridamole myocardial imaging: simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease. Italian Group of Nuclear Cardiology.
abstract: BACKGROUND
  Dipyridamole stress combined with echocardiography or perfusion scintigraphy can be used to detect coronary artery disease, but head-to-head comparative data are lacking. The aim of this study was to compare the relative accuracy of high-dose dipyridamole stress imaging (up to 0.84 mg/kg over 10 min) with two-dimensional echocardiography and sestamibi perfusion scintigraphy in detecting coronary artery disease.
  
  
  METHODS
  One-hundred and one patients with a history of chest pain and no previous myocardial infarction, were studied simultaneously using planar perfusion scintigraphy and echocardiography during a high-dose dipyridamole stress, at seven different institutions.
  
  
  RESULTS
  During coronary angiography, 21 patients had non-significant lesions, and 80 had significant lesions (> or = 50% diameter reduction): 37 had single-, 19 double- and 24 triple-vessel disease. Sensitivity for disease detection was 78% [95% confidence interval (CI) 67-86%] for echocardiography and 79% (CI 68-87%) for scintigraphy. The specificity was 76% (CI 67-84%) for echocardiography and 90% (CI 83-95%) for scintigraphy. The inter-center variation in accuracy ranged from 50 to 100% for echocardiography (coefficient of variation 19.7%) and from 71 to 100% for scintigraphy (coefficient of variation 15%). The angiographically assessed extent and severity of coronary artery disease, evaluated using the Duke score, was correlated to the extent and severity of perfusion defects with scintigraphy (r = 0.65, P < 0.0001) and regional wall motion abnormalities by echocardiography (r = 0.57, P < 0.0001).
  
  
  CONCLUSIONS
  Perfusion scintigraphy and echocardiography have similar accuracies for the non-invasive identification of angiographically assessed coronary artery disease during high-dose dipyridamole stress. Inter-center variability in diagnostic accuracy is higher for echocardiography than scintigraphy. Both methods allow a reasonably accurate estimation of extent and severity of disease, via a semiquantitative assessment of extent and severity of perfusion of functional defects.
authors.affiliation: CNR Institute of Clinical Physiology-Section of Milan, Piazza Ospedale, Milano-Niguarda, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Parodi
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: C
authors.initials: C
authors.lastname: Marcassa
authors.forename: R
authors.initials: R
authors.lastname: Sicari
authors.forename: P
authors.initials: P
authors.lastname: Marzullo
authors.forename: E
authors.initials: E
authors.lastname: Verna
authors.forename: G
authors.initials: G
authors.lastname: Bisi
authors.forename: M
authors.initials: M
authors.lastname: Galli
authors.forename: S
authors.initials: S
authors.lastname: Pirelli
authors.forename: E
authors.initials: E
authors.lastname: Inglese
authors.forename: O
authors.initials: O
authors.lastname: Parodi
authors.forename: G
authors.initials: G
authors.lastname: Sambuceti
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004176:Dipyridamole / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015635:Radionuclide Ventriculography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012449:Safety; D017256:Technetium Tc 99m Sestamibi; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi