TY - JOUR
T1 - Comparison of dobutamine and exercise using technetium-99m sestamibi imaging for the evaluation of coronary artery disease
AU - Herman, Steven D.
AU - LaBresh, Kenneth A.
AU - Santos-Ocampo, Carlo D.
AU - Garber, Carol Ewing
AU - Barbour, Marilyn M.
AU - Messinger, Debra E.
AU - Cloutier, Donna J.
AU - Ahlberg, Alan W.
AU - Heller, Gary V.
N1 - Funding Information:
From the Nuclear Cardiology Laboratory, Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket; the Department of Medicine, Brown University School of Medicine, Providence; and the Department of Pharmacy Practice, University of Rhode Island, Kingston, Rhode Island. This research was performed during Dr. Herman’s tenure as a Research Fellow of the American Heart Association, Rhode Island Affiliate, Pawtucket, Rhode Island. Partial funding for this study was provided by The Rhode Island Foundation, Providence, Rhode Island, and DuPont Radiopharmaceuticals, North Billerica, Massachusetts. Manuscript received April 27, 1993; revised manuscript received and accepted July 26, 1993.
PY - 1994/1/15
Y1 - 1994/1/15
N2 - Studies using dobutamine thallium-201 myocardial perfusion imaging have suggested a high sensitivity and specificity for the detection of coronary artery disease. However, few data are available comparing dobutamine with exercise stress for the detection and localization of perfusion defects. This study compared the effects of dobutamine and exercise stress using technetium-99m sestamibi single-photon emission computed tomographic imaging in the same patients in a prospective crossover trial. Twenty-four patients with a high likelihood of coronary artery disease underwent tomographic myocardial imaging at rest, after symptom-limited treadmill exercise, and after intravenous dobutamine (maximum 30 μg/kg/min). Tomograms of the left ventricle were divided into 20 segments and were interpreted without knowledge of patient identity or stress protocol. Dobutamine was well tolerated by all patients. Segment-by-segment concordance between exercise and dobutamine images was highly significant (kappa = 0.56, p < 0.0001). Global first-order agreement (normal vs abnormal) between exercise and dobutamine studies was 96% (kappa = 0.65, p = 0.02); global second-order agreement (normal vs fixed vs ischemic defect) was 88% (kappa = 0.45, p = 0.02). Regional first-and second-order agreement were 96 and 93%, respectively (p < 0.001 for both). Twenty patients underwent coronary angiography. Comparisons between exercise and angiography and between dobutamine and angiography were similar for both global agreement (95 vs 100%, p = NS) and regional agreement (77 vs 72%, p = NS). In conclusion, technetium-99m sestamibi tomograms obtained after exercise and dobutamine stress in the same patients with a high likelihood of coronary artery disease show very similar results with regard to the identification, localization and reversibility of perfusion defects.
AB - Studies using dobutamine thallium-201 myocardial perfusion imaging have suggested a high sensitivity and specificity for the detection of coronary artery disease. However, few data are available comparing dobutamine with exercise stress for the detection and localization of perfusion defects. This study compared the effects of dobutamine and exercise stress using technetium-99m sestamibi single-photon emission computed tomographic imaging in the same patients in a prospective crossover trial. Twenty-four patients with a high likelihood of coronary artery disease underwent tomographic myocardial imaging at rest, after symptom-limited treadmill exercise, and after intravenous dobutamine (maximum 30 μg/kg/min). Tomograms of the left ventricle were divided into 20 segments and were interpreted without knowledge of patient identity or stress protocol. Dobutamine was well tolerated by all patients. Segment-by-segment concordance between exercise and dobutamine images was highly significant (kappa = 0.56, p < 0.0001). Global first-order agreement (normal vs abnormal) between exercise and dobutamine studies was 96% (kappa = 0.65, p = 0.02); global second-order agreement (normal vs fixed vs ischemic defect) was 88% (kappa = 0.45, p = 0.02). Regional first-and second-order agreement were 96 and 93%, respectively (p < 0.001 for both). Twenty patients underwent coronary angiography. Comparisons between exercise and angiography and between dobutamine and angiography were similar for both global agreement (95 vs 100%, p = NS) and regional agreement (77 vs 72%, p = NS). In conclusion, technetium-99m sestamibi tomograms obtained after exercise and dobutamine stress in the same patients with a high likelihood of coronary artery disease show very similar results with regard to the identification, localization and reversibility of perfusion defects.
UR - http://www.scopus.com/inward/record.url?scp=0028117240&partnerID=8YFLogxK
U2 - 10.1016/0002-9149(94)90208-9
DO - 10.1016/0002-9149(94)90208-9
M3 - Article
C2 - 7905247
AN - SCOPUS:0028117240
SN - 0002-9149
VL - 73
SP - 164
EP - 169
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 2
ER -