Detection of coronary artery disease: comparison between technetium 99m-labeled sestamibi single-photon emission computed tomography and two-dimensional echocardiography with dipyridamole low-level exercise-stress
Related Experiment Videos
M J Cramer1, E E van der Wall, W Jaarsma
1Department of Cardiology, St. Antonius Hospital, Niewegein, The Netherlands.
Insights
Myocardial perfusion imaging using 99mTc-labeled sestamibi SPECT with dipyridamole stress is effective for evaluating coronary artery disease (CAD). Combining it with 2D echocardiography did not significantly improve diagnostic accuracy over SPECT alone.
Area of Science:
- Cardiology
- Medical Imaging
- Nuclear Medicine
Background:
- Myocardial perfusion imaging (MPI) with dipyridamole and low-level exercise is valuable for diagnosing coronary artery disease (CAD).
- Two-dimensional (2D) echocardiography for wall motion analysis may offer supplementary information to MPI.
- This study compares MPI and 2D echocardiography in evaluating CAD using a dipyridamole low-level bicycle exercise stress protocol.
Purpose of the Study:
- To compare the diagnostic accuracy of 99mTc-labeled sestamibi single-photon emission computed tomography (SPECT) and 2D echocardiography.
- To evaluate the effectiveness of these imaging modalities in patients undergoing a dipyridamole low-level bicycle exercise stress protocol for CAD assessment.
Main Methods:
- 35 consecutive patients with suspected CAD underwent coronary arteriography.
- 99mTc-labeled sestamibi SPECT and 2D echocardiography were performed.
- Diagnostic accuracy was assessed for overall CAD detection, segmental analysis, and specific coronary artery stenoses.
Main Results:
- Overall agreement between SPECT and 2D echocardiography for CAD detection was 80% (27/35 patients).
- Segmental agreement was 73% (124/170 segments).
- Combined assessment accuracy (86%) was not significantly better than SPECT alone (80%) but superior to 2D echocardiography alone (71%). SPECT showed higher accuracy for left anterior descending lesions (80% vs 60%).
Conclusions:
- Simultaneous assessment of myocardial perfusion (SPECT) and wall motion (2D echocardiography) did not significantly enhance overall accuracy compared to SPECT alone.
- 99mTc-labeled sestamibi SPECT with dipyridamole low-level exercise stress is the preferred imaging modality for evaluating patients with CAD.
Background:
Myocardial perfusion imaging in conjunction with dipyridamole low-level exercise stress has proved its value in the evaluation of patients with coronary artery disease (CAD). Simultaneous wall motion analysis by two-dimensional (2D) echocardiography may provide additional information beyond that obtained by myocardial perfusion imaging alone. The purpose of this study was to compare 99mTc-labeled sestamibi single-photon emission computed tomography (SPECT) and 2D echocardiography for the evaluation of CAD according to a dipyridamole low-level bicycle exercise stress protocol.
Methods And Results:
We studied 35 consecutive patients referred for the evaluation of chest pain who had undergone coronary arteriography. 99mTc-labeled sestamibi SPECT and 2D echocardiography agreed in 27 patients (80%) studied for overall detection of CAD. On a segmental basis, agreement was found between SPECT and 2D echocardiography in 124 (73%) of 170 segments (Cohen's kappa = 0.43). The accuracy of the combined assessment of myocardial perfusion and echocardiographic wall motion in detecting CAD was 86%, which was not different from the accuracy of SPECT alone (80%; difference not significant) but significantly higher than for 2D echocardiography alone (71%; p = 0.03). In the detection of individual coronary artery stenoses, SPECT had a significantly higher accuracy for detecting left anterior descending coronary artery lesions than had 2D echocardiography (80% vs 60%; p < 0.01); combining the two method did not improve the accuracy (80%). The combined assessment slightly improved the accuracy for detecting left circumflex coronary artery stenoses from 71% to 83% (p = 0.05).
Conclusion:
The combined simultaneous assessment of myocardial perfusion by 99mTc-labeled sestamibi SPECT and wall motion by 2D echocardiography did not significantly improve overall accuracy over that obtained by 99mTc-labeled sestamibi SPECT alone. Therefore 99mTc-labeled sestamibi SPECT with dipyridamole low-level exercise stress appears the preferred imaging modality for the evaluation of patients with CAD.