High dose dipyridamole myocardial imaging: Simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease

Guido Parodi, Eugenio Picano, Claudio Marcassa, Rosa Sicari, Paolo Marzullo, Edoardo Verna, Gianni Bisi, Michele Galli, Salvatore Pirelli, Eugenio Inglese, Oberdan Parodi, Gianmario Sambuceti

Research output: Contribution to journalArticle

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Abstract

Background. Dipyridamole stress combined with echocardiography or perfusion scintigraphy can be used to detect coronary artery disease, but head-to-head comparative data are lacking. The aim of this study was to compare the relative accuracy of high-dose dipyridamole stress imaging (up to 0.84 mg/kg over 10 min) with two-dimensional echocardiography and sestamibi perfusion scintigraphy in detecting coronary artery disease. Methods. One-hundred and one patients with a history of chest pain and no previous myocardial infarction, were studied simultaneously using planar perfusion scintigraphy and echocardiography during a high-dose dipyridamole stress, at seven different institutions. Results. During coronary angiography, 21 patients had non-significant lesions, and 80 had significant lesions (≥ 50% diameter reduction): 37 had single-, 19 double- and 24 triple-vessel disease. Sensitivity for disease detection was 78% [95% confidence interval (CI) 67-86%] for echocardiography and 79% (CI 68-87%) for scintigraphy. The specificity was 76% (CI 67-84%) for echocardiography and 90% (CI 83-95%) for scintigraphy. The inter-center variation in accuracy ranged from 50 to 100% for echocardiography (coefficient of variation 19.7%) and from 71 to 100% for scintigraphy (coefficient of variation 15%). The angiographically assessed extent and severity of coronary artery disease, evaluated using the Duke score, was correlated to the extent and severity of perfusion defects with scintigraphy (r = 0.65, P <0.0001) and regional wall motion abnormalities by echocardiography (r = 0.57, P <0.0001). Conclusions. Perfusion scintigraphy and echocardiography have similar accuracies for the non-invasive identification of angiographically assessed coronary artery disease during high-dose dipyridamole stress. Inter-center variability in diagnostic accuracy is higher for echocardiography than scintigraphy. Both methods allow a reasonably accurate estimation of extent and severity of disease, via a semiquantitative assessment of extent and severity of perfusion or functional defects.

Original languageEnglish
Pages (from-to)177-184
Number of pages8
JournalCoronary Artery Disease
Volume10
Issue number3
Publication statusPublished - 1999

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Dipyridamole
Radionuclide Imaging
Echocardiography
Coronary Artery Disease
Perfusion Imaging
Confidence Intervals
Perfusion
Coronary Angiography
Chest Pain
Myocardial Infarction

Keywords

  • Coronary artery disease
  • Dipyridamole
  • Perfusion scintigraphy
  • Stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

High dose dipyridamole myocardial imaging : Simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease. / Parodi, Guido; Picano, Eugenio; Marcassa, Claudio; Sicari, Rosa; Marzullo, Paolo; Verna, Edoardo; Bisi, Gianni; Galli, Michele; Pirelli, Salvatore; Inglese, Eugenio; Parodi, Oberdan; Sambuceti, Gianmario.

In: Coronary Artery Disease, Vol. 10, No. 3, 1999, p. 177-184.

Research output: Contribution to journalArticle

Parodi, Guido ; Picano, Eugenio ; Marcassa, Claudio ; Sicari, Rosa ; Marzullo, Paolo ; Verna, Edoardo ; Bisi, Gianni ; Galli, Michele ; Pirelli, Salvatore ; Inglese, Eugenio ; Parodi, Oberdan ; Sambuceti, Gianmario. / High dose dipyridamole myocardial imaging : Simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease. In: Coronary Artery Disease. 1999 ; Vol. 10, No. 3. pp. 177-184.
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abstract = "Background. Dipyridamole stress combined with echocardiography or perfusion scintigraphy can be used to detect coronary artery disease, but head-to-head comparative data are lacking. The aim of this study was to compare the relative accuracy of high-dose dipyridamole stress imaging (up to 0.84 mg/kg over 10 min) with two-dimensional echocardiography and sestamibi perfusion scintigraphy in detecting coronary artery disease. Methods. One-hundred and one patients with a history of chest pain and no previous myocardial infarction, were studied simultaneously using planar perfusion scintigraphy and echocardiography during a high-dose dipyridamole stress, at seven different institutions. Results. During coronary angiography, 21 patients had non-significant lesions, and 80 had significant lesions (≥ 50{\%} diameter reduction): 37 had single-, 19 double- and 24 triple-vessel disease. Sensitivity for disease detection was 78{\%} [95{\%} confidence interval (CI) 67-86{\%}] for echocardiography and 79{\%} (CI 68-87{\%}) for scintigraphy. The specificity was 76{\%} (CI 67-84{\%}) for echocardiography and 90{\%} (CI 83-95{\%}) for scintigraphy. The inter-center variation in accuracy ranged from 50 to 100{\%} for echocardiography (coefficient of variation 19.7{\%}) and from 71 to 100{\%} for scintigraphy (coefficient of variation 15{\%}). The angiographically assessed extent and severity of coronary artery disease, evaluated using the Duke score, was correlated to the extent and severity of perfusion defects with scintigraphy (r = 0.65, P <0.0001) and regional wall motion abnormalities by echocardiography (r = 0.57, P <0.0001). Conclusions. Perfusion scintigraphy and echocardiography have similar accuracies for the non-invasive identification of angiographically assessed coronary artery disease during high-dose dipyridamole stress. Inter-center variability in diagnostic accuracy is higher for echocardiography than scintigraphy. Both methods allow a reasonably accurate estimation of extent and severity of disease, via a semiquantitative assessment of extent and severity of perfusion or functional defects.",
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author = "Guido Parodi and Eugenio Picano and Claudio Marcassa and Rosa Sicari and Paolo Marzullo and Edoardo Verna and Gianni Bisi and Michele Galli and Salvatore Pirelli and Eugenio Inglese and Oberdan Parodi and Gianmario Sambuceti",
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T1 - High dose dipyridamole myocardial imaging

T2 - Simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease

AU - Parodi, Guido

AU - Picano, Eugenio

AU - Marcassa, Claudio

AU - Sicari, Rosa

AU - Marzullo, Paolo

AU - Verna, Edoardo

AU - Bisi, Gianni

AU - Galli, Michele

AU - Pirelli, Salvatore

AU - Inglese, Eugenio

AU - Parodi, Oberdan

AU - Sambuceti, Gianmario

PY - 1999

Y1 - 1999

N2 - Background. Dipyridamole stress combined with echocardiography or perfusion scintigraphy can be used to detect coronary artery disease, but head-to-head comparative data are lacking. The aim of this study was to compare the relative accuracy of high-dose dipyridamole stress imaging (up to 0.84 mg/kg over 10 min) with two-dimensional echocardiography and sestamibi perfusion scintigraphy in detecting coronary artery disease. Methods. One-hundred and one patients with a history of chest pain and no previous myocardial infarction, were studied simultaneously using planar perfusion scintigraphy and echocardiography during a high-dose dipyridamole stress, at seven different institutions. Results. During coronary angiography, 21 patients had non-significant lesions, and 80 had significant lesions (≥ 50% diameter reduction): 37 had single-, 19 double- and 24 triple-vessel disease. Sensitivity for disease detection was 78% [95% confidence interval (CI) 67-86%] for echocardiography and 79% (CI 68-87%) for scintigraphy. The specificity was 76% (CI 67-84%) for echocardiography and 90% (CI 83-95%) for scintigraphy. The inter-center variation in accuracy ranged from 50 to 100% for echocardiography (coefficient of variation 19.7%) and from 71 to 100% for scintigraphy (coefficient of variation 15%). The angiographically assessed extent and severity of coronary artery disease, evaluated using the Duke score, was correlated to the extent and severity of perfusion defects with scintigraphy (r = 0.65, P <0.0001) and regional wall motion abnormalities by echocardiography (r = 0.57, P <0.0001). Conclusions. Perfusion scintigraphy and echocardiography have similar accuracies for the non-invasive identification of angiographically assessed coronary artery disease during high-dose dipyridamole stress. Inter-center variability in diagnostic accuracy is higher for echocardiography than scintigraphy. Both methods allow a reasonably accurate estimation of extent and severity of disease, via a semiquantitative assessment of extent and severity of perfusion or functional defects.

AB - Background. Dipyridamole stress combined with echocardiography or perfusion scintigraphy can be used to detect coronary artery disease, but head-to-head comparative data are lacking. The aim of this study was to compare the relative accuracy of high-dose dipyridamole stress imaging (up to 0.84 mg/kg over 10 min) with two-dimensional echocardiography and sestamibi perfusion scintigraphy in detecting coronary artery disease. Methods. One-hundred and one patients with a history of chest pain and no previous myocardial infarction, were studied simultaneously using planar perfusion scintigraphy and echocardiography during a high-dose dipyridamole stress, at seven different institutions. Results. During coronary angiography, 21 patients had non-significant lesions, and 80 had significant lesions (≥ 50% diameter reduction): 37 had single-, 19 double- and 24 triple-vessel disease. Sensitivity for disease detection was 78% [95% confidence interval (CI) 67-86%] for echocardiography and 79% (CI 68-87%) for scintigraphy. The specificity was 76% (CI 67-84%) for echocardiography and 90% (CI 83-95%) for scintigraphy. The inter-center variation in accuracy ranged from 50 to 100% for echocardiography (coefficient of variation 19.7%) and from 71 to 100% for scintigraphy (coefficient of variation 15%). The angiographically assessed extent and severity of coronary artery disease, evaluated using the Duke score, was correlated to the extent and severity of perfusion defects with scintigraphy (r = 0.65, P <0.0001) and regional wall motion abnormalities by echocardiography (r = 0.57, P <0.0001). Conclusions. Perfusion scintigraphy and echocardiography have similar accuracies for the non-invasive identification of angiographically assessed coronary artery disease during high-dose dipyridamole stress. Inter-center variability in diagnostic accuracy is higher for echocardiography than scintigraphy. Both methods allow a reasonably accurate estimation of extent and severity of disease, via a semiquantitative assessment of extent and severity of perfusion or functional defects.

KW - Coronary artery disease

KW - Dipyridamole

KW - Perfusion scintigraphy

KW - Stress echocardiography

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