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Detection of coronary artery disease: Comparison between technetium 99m-labeled sestamibi single-photon emission computed tomography and two-dimensional echocardiography with dipyridamole low-level exercise-stress

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Myocardial perfusion imaging in conjunction with dipyridamole low-level exercise stress has proved its value in the evaluation of patients with coronary artery disease (CAD). Simultaneous wall motion analysis by two-dimensional (2D) echocardiography may provide additional information beyond that obtained by myocardial perfusion imaging alone. The purpose of this study was to compare 99mTc-labeled sestamibi single-photon emission computed tomography (SPECT) and 2D echocardiography for the evaluation of CAD according to a dipyridamole low-level bicycle exercise stress protocol.

Methods and Results

We studied 35 consecutive patients referred for the evaluation of chest pain who had undergone coronary arteriography. 99mTc-labeled sestamibi SPECT and 2D echocardiography agreed in 27 patients (80%) studied for overall detection of CAD. On a segmental basis, agreement was found between SPECT and 2D echocardiography in 124 (73%) of 170 segments (Cohen’s kappa=0.43). The accuracy of the combined assessment of myocardial perfusion and echocardiographic wall motion in detecting CAD was 86%, which was not different from the accuracy of SPECT alone (80%; difference not significant) but significantly higher than for 2D echocardiography alone (71%; p=0.03). In the detection of individual coronary artery stenoses, SPECT had a significantly higher accuracy for detecting left anterior descending coronary artery lesions than had 2D echocardiography (80% vs 60%; p<0.01); combining the two methods did not improve the accuracy (80%). The combined assessment slightly improved the accuracy for detecting left circumflex coronary artery stenoses from 71% to 83% (p=0.05).

Conclusion

The combined simultaneous assessment of myocardial perfusion by 99mTc-labeled sestamibi SPECT and wall motion by 2D echocardiography did not significantly improve overall accuracy over that obtained by 99mTc-labeled sestamibi SPECT alone. Therefore 99mTc-labeled sestamibi SPECT with dipyridamole low-level exercise stress appears the preferred imaging modality for the evaluation of patients with CAD.

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Authors and Affiliations

  1. Departments of Cardiology and Nuclear Medicine, St. Antonius Hospital, Niewegein, The Netherlands

    Maarten-Jan M. Cramer, Ernst E. van der Wall, Wybren Jaarsma, J. Fred Verzijlbergen, Menco G. Niemeyer, Aeilko H. Zwinderman & Ernest K. J. Pauwels

  2. Departments of Cardiology, Diagnostic Radiology and Nuclear Medicine, and Medical Statistics, Leiden University Hospital, Leiden, The Netherlands

    Maarten-Jan M. Cramer, Ernst E. van der Wall, Wybren Jaarsma, J. Fred Verzijlbergen, Menco G. Niemeyer, Aeilko H. Zwinderman & Ernest K. J. Pauwels

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  1. Maarten-Jan M. Cramer
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Cramer, MJ.M., van der Wall, E.E., Jaarsma, W. et al. Detection of coronary artery disease: Comparison between technetium 99m-labeled sestamibi single-photon emission computed tomography and two-dimensional echocardiography with dipyridamole low-level exercise-stress. J. Nucl. Cardiol. 3, 389–394 (1996). https://doi.org/10.1016/S1071-3581(96)90073-2

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  • DOI: https://doi.org/10.1016/S1071-3581(96)90073-2

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