VALUE OF DOBUTAMINE TECHNETIUM-99M-SESTAMIBI SPECT AND ECHOCARDIOGRAPHY IN THE DETECTION OF CORONARY-ARTERY DISEASE COMPARED WITH CORONARY ANGIOGRAPHY

The value of dobutamine echocardiography and Tc-99m-sestamibi SPECT im aging was evaluated as a noninvasive diagnostic method for assessing c oronary artery disease (CAD). Twenty-seven patients who underwent coro nary angiography were submitted to two separate injections of Tc-99m-s estamibi, one under control conditions and the other after reaching a peak dobutamine infusion rate. Simultaneous ECG and echocardiographic monitoring was also performed during stepwise dobutamine infusion. Whe reas the overall sensitivity and specificity of dobutamine sestamibi S PECT imaging were 94% and 88%, these values for dobutamine ECG and ech ocardiography were 61%, 55% and 84%, 88%, respectively. When dobutamin e echocardiography and Tc-99m-sestamibi SPECT imaging were evaluated t ogether, the diagnostic accuracy reaches almost 100%. Dobutamine echoc ardiography is of value in determining ischemic threshold earlier than clinical symptoms and allows simultaneous evaluation of ventricular p erformance and contractile function associated with perfusion abnormal ities on Tc-99m-sestamibi SPECT imaging. Our experience shows that Tc- 99m-sestamibi SPECT imaging, when combined with dobutamine echocardiog raphy, is a safe, practical, well tolerated method with high diagnosti c accuracy for the evaluation of CAD.