Comparison between dobutamine echocardiography and thallium‐201 scintigraphy in detecting residual stenosis, ischemia, and necrosis in patients with prior myocardial infarction

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 1997-04, Vol.20 (4), p.351-356
• Main Authors: Macieira‐Coelho, Eduardo, Dionísio, Isabel, Garcia‐Alves, MÁRio, Cantinho, Guilhermina, Da Costa, Brás B., Gouveia, AntÓNio, De Pádua, Fernando
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Clinical Investigation; Coronary Angiography; Coronary Circulation - physiology; Coronary Disease - diagnostic imaging; Coronary heart disease; Dobutamine; dobutamine echocardiography; Echocardiography - methods; Female; Heart; Heart - diagnostic imaging; Humans; Male; Medical sciences; Middle Aged; Myocardial Contraction - physiology; myocardial infarction; Myocardial Infarction - diagnostic imaging; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Thallium Radioisotopes; thallium scintigraphy
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960200410

Background: Following the first attempts to detect myocardial ischemia with two‐dimensional echocardiography stress testing, pharmacologic stress using dobutamine infusion has become an alternative to echocardiography exercise testing for evaluation of coronary artery disease. It has been shown that stress echocardiography has a diagnostic accuracy similar to that of an exercise thallium test. Other studies, however, indicated that radionuclide myocardial perfusion imaging was more sensitive than exercise or pharmacologic stress echocardiography for detection of ischemia or jeopardized myocardium. Hypothesis: The aim of the present study was to determine the ability of dobutamine stress echocardiography in comparison with thallium‐201 scintigraphy to identify multivessel disease and the presence of myocardial scar and ischemia in 60 consecutive patients who suffered a first myocardial infarction (MI). Methods: Patients were evaluated by coronary angiography and ventriculography, thallium‐201 (201Tl) tomographic scintigraphy, and dobutamine echocardiography within 3 months of a first MI. Forty‐seven had Q‐wave MI and 13 had non‐Q‐wave MI. Eleven patients were excluded from final analysis—7 because of failure to achieve target heart rate in spite of the use of atropine, and 4 because of high blood pressure following the infusion of dobutamine. Results: Dobutamine echocardiography showed an overall sensitivity of 43% for detection of coronary artery lesions of 50–74% diameter stenosis and 201Tl scintigraphy showed a sensitivity of 71%. For detection of lesions of ≥75% diameter stenosis, dobutamine echocardiography showed a sensitivity of 52% and 201Tl a sensitivity of 70%. Overall agreement between wall motion and myocardial perfusion for detection of necrosis and/or ischemia in the infarct area was 40.4% with a kappa coefficient of 0.09 (p = 0.13). For detection of ischemic myocardium outside the infarct zone, overall agreement was 78.6% with a kappa coefficient of 0.49 (p