[Echocardiography and MIBI-SPECT scintigraphy during dobutamine infusion in the diagnosis of coronary disease].

BACKGROUND AND PURPOSE

Dobutamine, an adrenergic agonist, has been combined with echocardiography and scintigraphy with MIBI-SPECT to detect coronary artery disease. Our purpose has been to compare echocardiography and MIBI-SPECT scintigraphy during dobutamine infusion for diagnosing coronary artery disease.

METHODS

Both tests and coronary angiography have been performed on 72 consecutive patients with chest pain and no previous history of coronary artery disease. Dobutamine had administered up to 40 micrograms/kg/min. Atropine was given when necessary. MIBI was injected at peak stress. Echocardiographic continuous monitoring and SPECT images were carried out. Positivity was defined as: 1) echocardiographic: wall motion abnormalities of new onset, and 2) scintigraphic: dobutamine-induced perfusion abnormalities.

RESULTS

Coronary artery disease was demonstrated in 49 patients. Echocardiography was positive in 37 of them (sensitivity of 75%) and MIBI-SPECT in 43 (sensitivity of 88%; p = NS). Specificity was higher with echocardiography (22/23, 96%) than with scintigraphy (16/23, 69%, p = 0.02). Accuracy was 82% for both tests. More patients with multivessel disease were detected by scintigraphy (61% versus 35%; p = 0.09). Agreement between tests was as follows: 1) results: 77% (kappa = 0.53); 2) segments: 86% (kappa = 0.65), and 3) artery diseased: 90% (kappa = 0.84).

CONCLUSIONS

Echocardiography and MIBI-SPECT in combination with doubtamine are useful techniques to detect coronary artery disease. Diagnostic accuracy is similar with both tests.