Journal of Nuclear Cardiology

, Volume 4, Issue 1, pp 18–24

Diagnostic accuracy of dipyridamole technetium 99m-labeled sestamibi myocardial tomography for detection of coronary artery disease

  • D. Douglas Miller
  • Liwa T. Younis
  • Bernard R. Chaitman
  • Henry Stratmann
Original Articles

DOI: 10.1016/S1071-3581(97)90045-3

Cite this article as:
Miller, D.D., Younis, L.T., Chaitman, B.R. et al. J Nucl Cardiol (1997) 4: 18. doi:10.1016/S1071-3581(97)90045-3

Abstract

Background

The diagnostic accuracy of exercise 99mTc-labeled sestamibi and intravenous dipyridamole 201Tl-labeled myocardial tomography is established. The accuracy of dipyridamole stress 99mTc-labeled sestamibi myocardial tomography for the detection of coronary artery disease has not been reported.

Methods and Results

Our purpose was to determine the diagnostic accuracy of same-day, rest-dipyridamole stress 99mTc-labeled sestamibi myocardial single-photon emission computed tomography (SPECT) compared with coronary angiography. Two hundred forty-four patients who were unable to exercise adequately underwent both dipyridamole 99mTc-labeled sestamibi SPECT and coronary angiography within 6 months. Dipyridamole was administered intravenously in a standard dose of 0.56 mg/kg for 4 minutes. Cardiac and noncardiac side effects were recorded. The presence of coronary stenoses of 50% or greater diameter reduction in each of the major coronary arteries was compared with imaging data in corresponding myocardial perfusion beds. The patient population was predominately (98.8%) male with a mean age of 63±9 years (range 33 to 83 years). The majority of patients had stable angina (88%). Eighty-four patients (35%) gave a prior history of myocardial infarction; 44 patients (18%) had a history of congestire heart failure. The principal limitation to exercise stress was peripheral vascular disease in 62 patients (26%). No serious side effects occurred during dipyridamole stress; 14% of patients had chest pain and 8% of patients had 1 mm or greater ST segment depression. Of the 204 patients with documented coronary stenoses, 43 (21%) had single-vessel disease and 161 (79%) had multivessel disease. The sensitivity was 93% (40/43 in patients with single-vessel disease) and 91% (146/161 in patients with multivessel disease). Overall sensitivity was 91%. The specificity was 28% (11/40) in this population with a high prestest probability of coronary artery disease and posttest referral for cardiac catheterization.

Conclusion

99mTc-labeled sestamibi myocardial tomography in conjunction with intravenous dipyridamole stress is a safe and sensitive method for the detection of coronary artery disease. The diagnostic accuracy of dipyridamole stress 99mTc-labeled sestamibi SPECT for the detection of coronary artery disease is similar to that reported for exercise stress 99mTc-labeled sestamibi tomography, making this a suitable alternative for the evaluation of patients who are unable to exercise adequately.

Key Words

single-photon emission computed tomography myocardial perfusion coronary artery disease dipyridamole diagnostic accuracy 

Copyright information

© American Society of Nuclear Cardiology 1997

Authors and Affiliations

  • D. Douglas Miller
    • 1
    • 2
  • Liwa T. Younis
    • 1
    • 2
  • Bernard R. Chaitman
    • 1
    • 2
  • Henry Stratmann
    • 1
    • 2
  1. 1.Division of Cardiology, Department of Internal MedicineSt. Louis University School of MedicineSt. Louis
  2. 2.John Cochran Veterans Administration Medical CenterSt. Louis
  3. 3.Department of Internal MedicineSt. Louis University Health Sciences CenterSt. Louis

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