Simultaneous dobutamine stress echocardiography and Tc-99m-tetrofosmin three-head single-photon emission computed tomography in patients with suspected coronary artery disease

Objectives and background Dobutamine stress echocardiography and Tc-99m-tet rofosmin single-photon emission computed tomography (T-SPECT) were performe d simultaneously in subjects in whom coronary artery disease (CAD) had been proven or excluded at coronary angiography, in order to establish their ac curacy and agreement in the diagnosis of CAD, and in localisation and evalu ation of the extension of ischaemia. No simultaneous comparison of the two techniques has been performed previously. Methods Seventy patients (50 men, mean age 63 +/- 10 years, 21 with previou s myocardial infarction) underwent simultaneous dobutamine stress echocardi ography and T-SPECT. The response to stress was blindly and independently a nalysed, adopting a 16-region segmentation and referring to the three major coronary arteries. Results Sixty-two patients (agreement 89%, kappa =0.776) and 91% of left ve ntricular regions (kappa =0.665) were classified concordantly, independentl y of the presence or absence of previous myocardial infarction (90%, kappa = 0.740 versus 91%, kappa = 0.589, respectively). At coronary angiography, 47 patients had CAD (disease prevalence 67%). The sensitivity and specifici ty of stress echocardiography for the diagnosis of anterior descending, cir cumflex and right coronary artery disease were 62, 78 and 73%, and 79, 79 a nd 83%, respectively. The corresponding values for T-SPECT were 70, 75 and 78%, and 94, 79 and 90%, respectively. Conclusions These data indicate a high concordance between wall motion abno rmalities observed using stress echocardiography and perfusion defects obse rved using T-SPECT; their sensitivity in identifying critical stenoses was similar. Inadequate stressor amounts, and less frequently hyperdynamic regi onal response may reduce the accuracy of stress echocardiography, while dob utamine effects on coronary flow may prevent T-SPECT from showing subtle fl ow maldistributions in the presence of worsened wall motion. Coronary Arter y Dis 10:479-487 (C) 1999 Lippincott Williams & Wilkins.