Diagnostic value of dobutamine stress echocardiography and exercise myocardial scintigraphy for restenosis at 6 months after angioplasty of the left anterior descending artery.

This study compared prospectively the diagnostic value of dobutamine echoca rdiography and exercise myocardial scintigraphy for restenosis at 6 months after angioplasty of the left anterior descending artery. Forty-one patients aged 58 +/- 10 years, admitted to hospital for myocardiu m infarction (N = 22) or unstable angina (N = 19), with single vessel disea se, were treated by angioplasty of one lesion of the left anterior descendi ng artery after initial evaluation of the left ventricular ejection fractio n by echocardiography. At 6 months. left ventricular function was reassesse d by echocardiography, dobutamine echocardiography and exercise myocardial scintigraphy (Thallium 201) performed without treatment. Coronary angiograp hy was performed at the same time and showed 8 restenoses (19.5%). Overall, in this series, dobutamine echo and scintigraphy had respectively a sensitivity of 37.5% and 75%, and a specificity of 97% and 70% (p < 0.02) . Nine patients had left Ventricular dysfunction unchanged compared with th e initial measurement without viability in the territory of the left anteri or descending artery with low dose dobutamine (group 1); thirty-two patient s had improved or normal left ventricular ejection fraction with myocardial viability (group 2). in group 1, no cases of restenosis were detected by d obutamine echocardiography but _ of them had myocardial scintigraphic evide nce of ischaemia. In group 2, the sensitivity of the two techniques was com parable but dobutamine echo was more specific than scintigraphy (96 versus 75%, p = 0.03). In conclusion, dobutamine echocardiography may be indicated in the diagnosi s of restenosis of the left anterior descending artery and in cases of viab ility in its territory. In its absence, myocardial scintigraphy seems to be preferable.