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. 2001 Nov;86(5):510–515. doi: 10.1136/heart.86.5.510

Dobutamine stress echocardiography versus quantitative technetium-99m sestamibi SPECT for detecting residual stenosis and multivessel disease after myocardial infarction

P Lancellotti 1, T Benoit 1, P Rigo 1, L Pierard 1
PMCID: PMC1729965  PMID: 11602542

Abstract

OBJECTIVE—To compare the relative accuracy of dobutamine stress echocardiography (DSE) and quantitative technetium-99m sestamibi single photon emission computed tomography (mibi SPECT) for detecting infarct related artery stenosis and multivessel disease early after acute myocardial infarction.
DESIGN—Prospective study.
SETTING—University hospital.
METHODS—75 patients underwent simultaneous DSE and mibi SPECT at (mean (SD)) 5 (2) days after a first acute myocardial infarct. Quantitative coronary angiography was performed in all patients after imaging studies.
RESULTS—Significant stenosis (> 50%) of the infarct related artery was detected in 69 patients. Residual ischaemia was identified by DSE in 55 patients and by quantitative mibi SPECT in 49. The sensitivity of DSE and mibi SPECT for detecting significant infarct related artery stenosis was 78% and 70%, respectively, with a specificity of 83% for both tests. The combination of DSE and mibi SPECT did not change the specificity (83%) but increased the sensitivity to 94%. Mibi SPECT was more sensitive than DSE for detecting mild stenosis (73% v 9%; p = 0.008). The sensitivity of DSE for detecting moderate or severe stenosis was greater than mibi SPECT (97% v 74%; p = 0.007). Wall motion abnormalities with DSE and transient perfusion defects with mibi SPECT outside the infarction zone were sensitive (80% v 67%; NS) and highly specific (95% v 93%; NS) for multivessel disease.
CONCLUSIONS—DSE and mibi SPECT have equivalent accuracy for detecting residual infarct related artery stenosis of ⩾ 50% and multivessel disease early after acute myocardial infarction. DSE is more predictive of moderate or severe infarct related artery stenosis. Combined imaging only improves the detection of mild stenosis.


Keywords: myocardial infarction; dobutamine echocardiography; single photon emission computed tomography; SPECT; myocardial ischaemia

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Figure 1  .

Figure 1  

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Bar graph showing accuracy of quantitative 99mTc sestamibi single photon emission computed tomography (mibi SPECT) and dobutamine stress echocardiography (DSE) for detecting residual infarct related artery stenosis, using different cut off values (50%, 60%, 70%). Black bars, residual ischaemia on DSE; white bars, residual ischaemia on mibi SPECT.

Figure 2  .

Figure 2  

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Bar graph showing sensitivity of quantitative 99mTc sestamibi single photon emission computed tomography (mibi SPECT) and dobutamine stress echocardiography (DSE) for detecting multivessel disease. Black bars, residual ischaemia on DSE; white bars, residual ischaemia on mibi SPECT.

Selected References

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