Open AccessComparison between dobutamine echocardiography and thallium‐201 scintigraphy in detecting residual stenosis, ischemia, and necrosis in patients with prior myocardial infarction
Author(s) -
MacieiraCoelho Eduardo,
Dionísio Isabel,
GarciaAlves MÁRio,
Cantinho Guilhermina,
Da Costa Brás B.,
Gouveia AntÓNio,
De Pádua Fernando
Publication year - 1997
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960200410
Subject(s) - medicine , dobutamine , cardiology , coronary artery disease , scintigraphy , myocardial infarction , thallium , stress echocardiography , ischemia , stenosis , perfusion , radionuclide ventriculography , radiology , heart failure , hemodynamics , ejection fraction , inorganic chemistry , chemistry
Background : Following the first attempts to detect myocardial ischemia with two‐dimensional echocardiography stress testing, pharmacologic stress using dobutamine infusion has become an alternative to echocardiography exercise testing for evaluation of coronary artery disease. It has been shown that stress echocardiography has a diagnostic accuracy similar to that of an exercise thallium test. Other studies, however, indicated that radionuclide myocardial perfusion imaging was more sensitive than exercise or pharmacologic stress echocardiography for detection of ischemia or jeopardized myocardium. Hypothesis : The aim of the present study was to determine the ability of dobutamine stress echocardiography in comparison with thallium‐201 scintigraphy to identify multivessel disease and the presence of myocardial scar and ischemia in 60 consecutive patients who suffered a first myocardial infarction (MI). Methods : Patients were evaluated by coronary angiography and ventriculography, thallium‐201 ( 201 Tl) tomographic scintigraphy, and dobutamine echocardiography within 3 months of a first MI. Forty‐seven had Q‐wave MI and 13 had non‐Q‐wave MI. Eleven patients were excluded from final analysis—7 because of failure to achieve target heart rate in spite of the use of atropine, and 4 because of high blood pressure following the infusion of dobutamine. Results : Dobutamine echocardiography showed an overall sensitivity of 43% for detection of coronary artery lesions of 50–74% diameter stenosis and 201 Tl scintigraphy showed a sensitivity of 71%. For detection of lesions of ≥75% diameter stenosis, dobutamine echocardiography showed a sensitivity of 52% and 201 Tl a sensitivity of 70%. Overall agreement between wall motion and myocardial perfusion for detection of necrosis and/or ischemia in the infarct area was 40.4% with a kappa coefficient of 0.09 (p = 0.13). For detection of ischemic myocardium outside the infarct zone, overall agreement was 78.6% with a kappa coefficient of 0.49 (p<0.0001). Conclusion : Dobutamine echocardiography results showed a lower sensitivity than myocardial perfusion images in predicting multivessel coronary artery disease, and there was poor agreement between both methods in identifying necrosis or ischemia.