title: Dobutamine stress myocardial perfusion imaging.
abstract: In patients with limited exercise capacity and (relative) contraindications to direct vasodilators such as dipyridamole or adenosine, dobutamine stress nuclear myocardial perfusion imaging (DSMPI) represents an alternative, exercise-independent stress modality for the detection of coronary artery disease (CAD). Nondiagnostic test results (absence of reversible perfusion defects with submaximal stress) do occur in approximately 10% of patients. Serious side effects during DSMPI are rare, with no death, myocardial infarction or ventricular fibrillation reported in three DSMPI safety reports for a total of 2,574 patients. On the basis of a total number of 1,014 patients reported in 20 studies, the sensitivity, specificity and accuracy of the test for the detection of CAD were 88%, 74% and 84%, respectively. Mean sensitivities for one-, two- and three-vessel disease were 84%, 95% and 100%, respectively. The sensitivity for detection of left circumflex CAD (50%) was lower, compared with that for left anterior descending CAD (68%) and right CAD (88%). The sensitivity of predicting multivessel disease by multiregion perfusion abnormalities varied widely, from 44% to 89%, although specificity was excellent in all studies (89% to 94%). In direct diagnostic comparisons, DSMPI was more sensitive, but less specific, than dobutamine stress echocardiography and comparable with direct vasodilator myocardial perfusion imaging. In the largest prognostic study, patients with a normal DSMPI study had an annual hard event rate less than 1%. An ischemic scan pattern provided independent prognostic value, with a direct relationship between the extent and severity of the perfusion defects and prognosis. In conclusion, DSMPI seems a safe and useful nonexercise-dependent stress modality to detect CAD and assess prognosis.
authors: Thoraxcenter Rotterdam, University Hospital, Rotterdam-Dijkzigt, The Netherlands. ml.geleijnse@worldonline.nl
authors: M L
authors: ML
authors: Geleijnse
authors: A
authors: A
authors: Elhendy
authors: P M
authors: PM
authors: Fioretti
authors: J R
authors: JR
authors: Roelandt
mesh_terms: D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine; D005080:Exercise Test; D005240:Feasibility Studies; D006801:Humans; D011379:Prognosis; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014664:Vasodilation / Q000187:drug effects
chemical_list: D002316:Cardiotonic Agents; D013794:Thallium Radioisotopes; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi