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Technetium-99m sestamibi myocardial tomography based on dipyridamole echocardiography testing in hypertensive patients with chest pain

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Abstract

The non-invasive diagnosis of coronary artery disease in hypertensives with chest pain is an important clinical concern because all exercise-dependent tests display limited feasibility and diagnostic accuracy; by contrast, dipyridamole echocardiography testing has been shown to have a similar feasibility and accuracy in hypertensive and normotensive subjects. The aim of this study was to evaluate the diagnostic capability of technetium-99m sestamibi tomography based on dipyridamole echocardiography testing in hypertensives with chest pain, and to compare the scintigraphic results with those of coronary angiography, exercise electrocardiography and dipyridamole echocardiography. Forty subjects with mild to moderate hypertension, chest pain and no previous myocardial infarction were submitted to99mTc-sestamibi tomography (at rest and after high-dose dipyridamole echocardiography) and to exercise electrocardiography testing. At coronary angiography 22 patients (group A) had significant epicardial coronary artery disease (≥70% stenosis of at least one major vessel) and 18 normal main coronary vessels (group B). Dipyridamole99mTc-sestamibi imaging was positive in 21/22 patients of group A and in 5/18 of group B. Dipyridamole echocardiography was positive in 18/22 patients of group A and in 5/18 of group B. Exercise electrocardiography was positive in 15/22 patients of group A and in 11/18 of group B. Four out of five subjects in group B with positive results in all the tests showed a slow run-off of angiographic contrast medium, probably due to small-vessel disease. Significant epicardial coronary artery disease in hypertensives with chest pain is unlikely when dipyridamole99mTc-sestamibi tomography is negative. When scintigraphy is positive, either epicardial coronary artery disease or a small-vessel disease condition is possible. The association of scintigraphy with dipyridamole echocardiography testing allows the assessment of contractile function and myocardial perfusion by a single pharmacological stress.

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Authors and Affiliations

  1. Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University “La Sapienza”, Rome, Italy

    Orazio Schillaci, Francesco Scopinaro, Rosanna Tavolaro, Roberta Danieli & Antonio Centi Colella

  2. Department of Internal Medicine, University “La Sapienza”, Rome, Italy

    Carlo Moroni, Alfredo Bossini & Rosario Cassone

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  1. Orazio Schillaci
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  2. Carlo Moroni
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  3. Francesco Scopinaro
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  4. Rosanna Tavolaro
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  5. Roberta Danieli
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  6. Alfredo Bossini
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  7. Rosario Cassone
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  8. Antonio Centi Colella
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Schillaci, O., Moroni, C., Scopinaro, F. et al. Technetium-99m sestamibi myocardial tomography based on dipyridamole echocardiography testing in hypertensive patients with chest pain. Eur J Nucl Med 24, 774–778 (1997). https://doi.org/10.1007/BF00879666

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  • DOI: https://doi.org/10.1007/BF00879666

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