Dipyridamole stress echocardiography vs dipyridamole sestamibi scintigraphy for diagnosing coronary artery disease in left bundle-branch block

C. Vigna, M. Stanislao, V. De Rito, A. Russo, R. Natali, T. Santoro, F. Loperfido

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Study objectives: To evaluate dipyridamole stress echocardiography (DSE) for predicting coronary artery diseases (CADS) in patients with complete left bundle-branch block (LBBB). Design: Comparison of DSE and dipyridamole sestamibi myocardial perfusion scintigraphy (sestamibi). Setting: Tertiary-care cardiac referral center. Patients: Fifty-four consecutive patients (26 men; mean [± SD] age, 59 ± 7 years) with complete LBBB (14 patients with left ventricular [LV] dilatation) and intermediate probability of CAD. Methods: Simultaneous single photon emission CT scan (20 mCi technetium Tc 99m stress/rest sestamibi) and echocardiography (second harmonic imaging) during a two-step (0.56 to 0.84 mg/kg) dipyridamole infusion protocol. Two sestamibi readings were performed. The first reading considered only those studies with reversible defects (sestamibi-1) to be positive. The second reading considered those studies with any defect (sestamibi-2) to be positive. CAD was defined as a ≥ 50% reduction in diameter in at least one major vessel seen on coronary angiography. Results: CAD was present in 17 patients (31.5%). The global predictive accuracy for CAD was significantly higher for DSE (87.0%) and sestamibi-1 (79.6%) than for sestamibi-2 (57.4%) [p <0.01 vs DSE; p <0.05 vs sestamibi-1]. No significant differences in sensitivity were present, but specificity was significantly higher for DSE (94.6%) and sestamibi-1 (81.1%) than for sestamibi-2 (43.2%; p <0.01 vs both the other two tests). Of 14 patients with LV dilatation, 26.8% were falsely positive for CAD (in some cases for posterior defects) as determined by sestamibi-1 and 64.3% were falsely positive for CAD by sestamibi-2 vs none by DSE. Conclusions: DSE is at least as accurate as dipyridamole sestamibi scintigraphy for predicting CAD in patients with complete LBBB and tends to be more specific in those patients with underlying LV dilatation.

Original languageEnglish
Pages (from-to)1534-1539
Number of pages6
JournalChest
Volume120
Issue number5
DOIs
Publication statusPublished - 2001

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Stress Echocardiography
Bundle-Branch Block
Dipyridamole
Radionuclide Imaging
Coronary Artery Disease
Reading
Dilatation
Myocardial Perfusion Imaging
Perfusion Imaging
Technetium
Tertiary Healthcare
Single-Photon Emission-Computed Tomography
Coronary Angiography
Echocardiography
Referral and Consultation

Keywords

  • Left bundle-branch block
  • Myocardial perfusion scintigraphy
  • Stress echocardiography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Dipyridamole stress echocardiography vs dipyridamole sestamibi scintigraphy for diagnosing coronary artery disease in left bundle-branch block. / Vigna, C.; Stanislao, M.; De Rito, V.; Russo, A.; Natali, R.; Santoro, T.; Loperfido, F.

In: Chest, Vol. 120, No. 5, 2001, p. 1534-1539.

Research output: Contribution to journalArticle

Vigna, C, Stanislao, M, De Rito, V, Russo, A, Natali, R, Santoro, T & Loperfido, F 2001, 'Dipyridamole stress echocardiography vs dipyridamole sestamibi scintigraphy for diagnosing coronary artery disease in left bundle-branch block', Chest, vol. 120, no. 5, pp. 1534-1539. https://doi.org/10.1378/chest.120.5.1534
Vigna, C. ; Stanislao, M. ; De Rito, V. ; Russo, A. ; Natali, R. ; Santoro, T. ; Loperfido, F. / Dipyridamole stress echocardiography vs dipyridamole sestamibi scintigraphy for diagnosing coronary artery disease in left bundle-branch block. In: Chest. 2001 ; Vol. 120, No. 5. pp. 1534-1539.
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title = "Dipyridamole stress echocardiography vs dipyridamole sestamibi scintigraphy for diagnosing coronary artery disease in left bundle-branch block",
abstract = "Study objectives: To evaluate dipyridamole stress echocardiography (DSE) for predicting coronary artery diseases (CADS) in patients with complete left bundle-branch block (LBBB). Design: Comparison of DSE and dipyridamole sestamibi myocardial perfusion scintigraphy (sestamibi). Setting: Tertiary-care cardiac referral center. Patients: Fifty-four consecutive patients (26 men; mean [± SD] age, 59 ± 7 years) with complete LBBB (14 patients with left ventricular [LV] dilatation) and intermediate probability of CAD. Methods: Simultaneous single photon emission CT scan (20 mCi technetium Tc 99m stress/rest sestamibi) and echocardiography (second harmonic imaging) during a two-step (0.56 to 0.84 mg/kg) dipyridamole infusion protocol. Two sestamibi readings were performed. The first reading considered only those studies with reversible defects (sestamibi-1) to be positive. The second reading considered those studies with any defect (sestamibi-2) to be positive. CAD was defined as a ≥ 50{\%} reduction in diameter in at least one major vessel seen on coronary angiography. Results: CAD was present in 17 patients (31.5{\%}). The global predictive accuracy for CAD was significantly higher for DSE (87.0{\%}) and sestamibi-1 (79.6{\%}) than for sestamibi-2 (57.4{\%}) [p <0.01 vs DSE; p <0.05 vs sestamibi-1]. No significant differences in sensitivity were present, but specificity was significantly higher for DSE (94.6{\%}) and sestamibi-1 (81.1{\%}) than for sestamibi-2 (43.2{\%}; p <0.01 vs both the other two tests). Of 14 patients with LV dilatation, 26.8{\%} were falsely positive for CAD (in some cases for posterior defects) as determined by sestamibi-1 and 64.3{\%} were falsely positive for CAD by sestamibi-2 vs none by DSE. Conclusions: DSE is at least as accurate as dipyridamole sestamibi scintigraphy for predicting CAD in patients with complete LBBB and tends to be more specific in those patients with underlying LV dilatation.",
keywords = "Left bundle-branch block, Myocardial perfusion scintigraphy, Stress echocardiography",
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T1 - Dipyridamole stress echocardiography vs dipyridamole sestamibi scintigraphy for diagnosing coronary artery disease in left bundle-branch block

AU - Vigna, C.

AU - Stanislao, M.

AU - De Rito, V.

AU - Russo, A.

AU - Natali, R.

AU - Santoro, T.

AU - Loperfido, F.

PY - 2001

Y1 - 2001

N2 - Study objectives: To evaluate dipyridamole stress echocardiography (DSE) for predicting coronary artery diseases (CADS) in patients with complete left bundle-branch block (LBBB). Design: Comparison of DSE and dipyridamole sestamibi myocardial perfusion scintigraphy (sestamibi). Setting: Tertiary-care cardiac referral center. Patients: Fifty-four consecutive patients (26 men; mean [± SD] age, 59 ± 7 years) with complete LBBB (14 patients with left ventricular [LV] dilatation) and intermediate probability of CAD. Methods: Simultaneous single photon emission CT scan (20 mCi technetium Tc 99m stress/rest sestamibi) and echocardiography (second harmonic imaging) during a two-step (0.56 to 0.84 mg/kg) dipyridamole infusion protocol. Two sestamibi readings were performed. The first reading considered only those studies with reversible defects (sestamibi-1) to be positive. The second reading considered those studies with any defect (sestamibi-2) to be positive. CAD was defined as a ≥ 50% reduction in diameter in at least one major vessel seen on coronary angiography. Results: CAD was present in 17 patients (31.5%). The global predictive accuracy for CAD was significantly higher for DSE (87.0%) and sestamibi-1 (79.6%) than for sestamibi-2 (57.4%) [p <0.01 vs DSE; p <0.05 vs sestamibi-1]. No significant differences in sensitivity were present, but specificity was significantly higher for DSE (94.6%) and sestamibi-1 (81.1%) than for sestamibi-2 (43.2%; p <0.01 vs both the other two tests). Of 14 patients with LV dilatation, 26.8% were falsely positive for CAD (in some cases for posterior defects) as determined by sestamibi-1 and 64.3% were falsely positive for CAD by sestamibi-2 vs none by DSE. Conclusions: DSE is at least as accurate as dipyridamole sestamibi scintigraphy for predicting CAD in patients with complete LBBB and tends to be more specific in those patients with underlying LV dilatation.

AB - Study objectives: To evaluate dipyridamole stress echocardiography (DSE) for predicting coronary artery diseases (CADS) in patients with complete left bundle-branch block (LBBB). Design: Comparison of DSE and dipyridamole sestamibi myocardial perfusion scintigraphy (sestamibi). Setting: Tertiary-care cardiac referral center. Patients: Fifty-four consecutive patients (26 men; mean [± SD] age, 59 ± 7 years) with complete LBBB (14 patients with left ventricular [LV] dilatation) and intermediate probability of CAD. Methods: Simultaneous single photon emission CT scan (20 mCi technetium Tc 99m stress/rest sestamibi) and echocardiography (second harmonic imaging) during a two-step (0.56 to 0.84 mg/kg) dipyridamole infusion protocol. Two sestamibi readings were performed. The first reading considered only those studies with reversible defects (sestamibi-1) to be positive. The second reading considered those studies with any defect (sestamibi-2) to be positive. CAD was defined as a ≥ 50% reduction in diameter in at least one major vessel seen on coronary angiography. Results: CAD was present in 17 patients (31.5%). The global predictive accuracy for CAD was significantly higher for DSE (87.0%) and sestamibi-1 (79.6%) than for sestamibi-2 (57.4%) [p <0.01 vs DSE; p <0.05 vs sestamibi-1]. No significant differences in sensitivity were present, but specificity was significantly higher for DSE (94.6%) and sestamibi-1 (81.1%) than for sestamibi-2 (43.2%; p <0.01 vs both the other two tests). Of 14 patients with LV dilatation, 26.8% were falsely positive for CAD (in some cases for posterior defects) as determined by sestamibi-1 and 64.3% were falsely positive for CAD by sestamibi-2 vs none by DSE. Conclusions: DSE is at least as accurate as dipyridamole sestamibi scintigraphy for predicting CAD in patients with complete LBBB and tends to be more specific in those patients with underlying LV dilatation.

KW - Left bundle-branch block

KW - Myocardial perfusion scintigraphy

KW - Stress echocardiography

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