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Incremental diagnostic value of dobutamine stress echocardiography and dobutamine scintigraphy (technetium 99m-labeled sestamibi single-photon emission computed tomography) for assessment of presence and extent of coronary artery disease

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The incremental diagnostic value of dobutamine stress echocardiography (DSE) and 99mTc-labeled sestamibi single-photon emission computed tomography for the evaluation of the presence and extent of coronary artery disease (CAD) was assessed with ordered logistic regression and receiver-operating characteristic curves.

Methods and Results

Forty-five consecutive patients (33 men and 12 women; 53±6.8 years) underwent exercise electrocardiography and simultaneous DSE and sestamibi single-photon emission computed tomographic imaging. Coronary angiography was performed in all patients (significant coronary stenosis >50%). On the basis of the results of exercise electrocardiography, the pretest probability for CAD (Diamond's algorithm) was low (45.6%±12.7%). According to ordered logistic regression analysis, some models were estimated that performed a diagnostic accuracy level for CAD. In particular, we evaluated a clinical model (model 1) determined by the following parameters: sex, age, presence of chest pain, and positivity of electrocardiogram during dobutamine stress test. This model was 64.3%±10.7% accurate for the prediction of CAD. The addition to model 1 of DSE parameters (wall motion stress and rest score index and relative difference) (model 2) yielded a diagnostic accuracy of 81.4%±4.3% (p<0.045), whereas the addition to model 1 of single-photon emission computed tomographic parameters (the difference between perfusional stress and rest score index) (model 3) improved diagnostic accuracy to 92.3%±5.5% (p<0.003), a level that appeared significantly higher than that of model 2 (p<0.016).

Conclusion

Both noninvasive methods for the detection of CAD showed a good diagnostic accuracy, especially when test-derived parameters were combined with clinical data. Nevertheless, the single-photon emission computed tomographic model showed a higher sensitivity compared with the DSE model.

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Authors and Affiliations

  1. Second Institute of Clinical Medicine and Nuclear Medicine Centre, University of Pisa, Pisa, Italy

    Vitantonio Di Bello, Calogero Riccardo Bellina, Enrico Gori, Nicola Molea, Luigi Talarico, Giuseppe Boni, Enrico Magagnini, Federica Matteucci, Davide Giorgi, Elena Lazzeri, Alessio Bertini, Maria Francesca Romano, Romano Bianchi & Costantino Giusti

  2. Department of Statistics and Mathematics Applied to Economics, University of Pisa, Pisa, Italy

    Vitantonio Di Bello, Calogero Riccardo Bellina, Enrico Gori, Nicola Molea, Luigi Talarico, Giuseppe Boni, Enrico Magagnini, Federica Matteucci, Davide Giorgi, Elena Lazzeri, Alessio Bertini, Maria Francesca Romano, Romano Bianchi & Costantino Giusti

  3. Department of Statistics, University of Florence, Florence, Italy

    Vitantonio Di Bello, Calogero Riccardo Bellina, Enrico Gori, Nicola Molea, Luigi Talarico, Giuseppe Boni, Enrico Magagnini, Federica Matteucci, Davide Giorgi, Elena Lazzeri, Alessio Bertini, Maria Francesca Romano, Romano Bianchi & Costantino Giusti

  4. Division of Cardiovascular Medicine, Hospital of Pisa, Pisa, Italy

    Vitantonio Di Bello, Calogero Riccardo Bellina, Enrico Gori, Nicola Molea, Luigi Talarico, Giuseppe Boni, Enrico Magagnini, Federica Matteucci, Davide Giorgi, Elena Lazzeri, Alessio Bertini, Maria Francesca Romano, Romano Bianchi & Costantino Giusti

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  1. Vitantonio Di Bello
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Di Bello, V., Bellina, C.R., Gori, E. et al. Incremental diagnostic value of dobutamine stress echocardiography and dobutamine scintigraphy (technetium 99m-labeled sestamibi single-photon emission computed tomography) for assessment of presence and extent of coronary artery disease. J Nucl Cardiol 3, 212–220 (1996). https://doi.org/10.1016/S1071-3581(96)90035-5

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  • DOI: https://doi.org/10.1016/S1071-3581(96)90035-5

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