DOBUTAMINE STRESS ECHOCARDIOGRAPHY AND PE RFUSION SCINTIGRAPHY FOR DETECTION OF INDUCIBLE ISCHEMIA IN PATIENTS WITH AND WITHOUT PREVIOUS MYOCARDIAL-INFARCTION

Dobutamine stress echocardiography has proven to be a method with high diagnostic accuracy in the detection of coronary artery disease. In c ase of previous myocardial infarction it is of importance to detect ad ditional regions with inducible myocardial ischemia. This study aimed at the detection of inducible ischemia by dobutamine stress echocardio graphy and stress perfusion scintigraphy in patients without and with previous myocardial infarction. 50 patients without as well as 50 pati ents with previous transmural myocardial infarction were investigated. In all patients coronary angiography, technetium-99m methoxy-isobutyl -isonitrile (MIBI)-SPECT after bicycle ergometry and dobutamine stress echocardiography (up to 40 mcg/kg/min dobutamine, 1 mg atropine) were performed within 14 days. In patients with previous myocardial infarc tion dobutamine stress echocardiography and MIBI-SPECT had similar sen sitivities (91 vs. 94 %, n.s.) and specificities (81 vs. 75 %; n.s.) i n the detection of significant coronary artery disease. Agreement on t he presence or absence of inducible ischemia was 84 % (Kappa = 0.60). In patients with previous transmural myocardial infarction sensitivity of stress echocardiography and perfusion scintigraphy in the detectio n of significant coronary artery disease is lower with 63 % and 77 %, respectively. In this patient group transient perfusion defects were f ound more frequently than inducible wall motion abnormalities, 76 % an d 60 %, respectively. There was a lower agreement (76 %; Kappa = 0.49) in the detection of abnormal or normal results between dobutamine ech ocardiography and stress perfusion scintigraphy for this group of pati ents. Conclusion: This study demonstrates high agreement of dobutamine stress echocardiography and stress perfusion scintigraphy in the eval uation inducible ischemia in patients without previous transmural myoc ardial infarction and equal diagnostic accuracy in the detection of co ronary artery disease. In patients with previous myocardial infarction there is a lower agreement in the interpretation of patients as havin g ischemia due to negative dobutamine echo results in patients having positive perfusion scintigraphies.