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 journalArticlepeer-review

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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