Transesophageal Atrial Pacing during Echocardiography Exams

Accuracy of Dobutamine Technetium 99m Sestamibi SPECT Imaging for the Diagnosis of Single-Vessel Coronary Artery Disease: Comparison with Echocardiography.

Elhendy A, van Domburg, R, Bax J, Poldermans D, Sozzi F, Roelandt, J. Thoraxcenter and the Department of Nuclear Medicine, University Hospital, Rotterdam, The Netherlands. Am Heart J 139(2):224-230, 2000. Background: Recent experimental studies have shown that technetium 99m methoxyisobutyl isonitrile (MIBI) underestimates flow heterogeneity induced by dobutamine and that this might have an impact on the sensitivity of dobutamine MIBI in patients with single-vessel coronary artery disease (CAD). This study compares the accuracy of dobutamine MIBI single-photon emission computed tomography (SPECT) and simultaneous echocardiography in the diagnosis of single-vessel CAD. Methods and Results: Ninety-one patients (age 57 ± 12 years) with single-vessel CAD or without significant CAD were studied with dobutamine (up to 40 ?g/kg per minute)-atropine (up to 1 mg) stress echocardiography (DSE) and simultaneous MIBI SPECT imaging. CAD was predicted on the basis of myocardial ischemia (transient wall motion abnormalities by DSE and reversible perfusion defects by MIBI). Ischemia was detected by MIBI in 30 of the 54 patients with and in 10 of the 37 patients without significant single-vessel CAD (sensitivity 56%, confidence interval [CI] 45 to 66; specificity 73%, CI 64 to 82; accuracy 63%, CI 53 to 73). Ischemia was detected by DSE in 30 patients with and in 6 patients without significant CAD (sensitivity of DSE 56%, CI 45 to 66; specificity 84%, CI 76 to 91; accuracy 67%, CI 57 to 77, P = not significant vs MIBI). For both imaging methods, sensitivity was significantly higher in patients with left anterior descending than in patients with left circumflex or right coronary artery stenosis (75% vs 40%, P < .05). The addition of echocardiography to MIBI did not improve the diagnostic accuracy (68% CI 59 to 78, P = not significant vs DSE or MIBI alone). Conclusions: DSE and MIBI SPECT imaging have similar moderate sensitivity for the diagnosis of single-vessel CAD. Sensitivity of each of these techniques is higher in patients with left anterior descending than in patients with left circumflex or right coronary artery stenosis. There is no improvement of diagnostic accuracy by use of the combination of both techniques.

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