SYNERGISTIC VALUE OF SIMULTANEOUS STRESS DOBUTAMINE SESTAMIBI SINGLE-PHOTON-EMISSION COMPUTERIZED-TOMOGRAPHY AND ECHOCARDIOGRAPHY IN THE DETECTION OF CORONARY-ARTERY DISEASE

The relative value of exercise electrocardiography, simultaneous dobut amine technetium 99m-sestamibi (MIBI) single-photon-emission computeri zed tomography (SPECT), and echocardiography were evaluated for the di agnosis of coronary artery disease in patients with chest pain. Sixty- one consecutive patients underwent exercise electrocardiography and si multaneous graded dobutamine echocardiography and MIBI imaging. All pa tients underwent coronary arteriography. The exercise electrocardiogra m was found to be a poor predictor of coronary artery disease (p not s ignificant). Individually, MIBI SPECT and echocardiography were signif icantly predictive of coronary artery disease (p < 0.001). According t o logistic regression analysis, the combined imaging modalities signif icantly increased the prediction of coronary artery disease for any ve ssel (p < 0.001), for multiple vessels (p < 0.001), and for the left a nterior descending (p ( 0.001), for right coronary artery (p < 0.001), and for left circumflex arteries (p < 0.01), compared with either MIB I SPECT or echocardiography alone. The results suggest a synergism in the detection of coronary artery disease when MIBI SPECT and echocardi ography are combined during dobutamine stress.