Dobutamine stress echocardiography and thallium-201 myocardial perfusion scintigraphy are clinically useful methods for the
evaluation of coronary artery disease (CAD). However, the relative merits of these imaging modalities in the evaluation of
the extent of CAD after myocardial infarction have not been well studied. The aim of this study was to compare the accuracy
of dobutamine stress echocardiography and simultaneous
201Tl single-photon emission tomography (SPET) imaging for the diagnosis and localization of CAD late after acute myocardial
infarction. Dobutamine (up to 40 μg kg
–1 min
–1)-atropine (up to 1 mg) stress echocardiography in conjunction with stress-reinjection
201Tl SPET was performed for the evaluation of myocardial ischaemia in 90 patients with previous myocardial infarction who underwent
coronary angiography. Significant CAD was predicted on bases of myocardial ischemia (new or worsening wall motion abnormalities
on echocardiography and reversible perfusion defects on
201Tl SPET). Significant CAD (≥ 50% luminal diameter stenosis) was detected in 73 (81%) patients. The sensitivity, specificity
and accuracy of echocardiography in detecting remote ischaemia for the diagnosis of remote CAD (present in 53 patients) were,
respectively, 79% (CI 70%–88%), 85% (CI 77%–93%) and 81% (CI 73%–90%), while the corresponding figures for
201Tl SPET were 75% (CI 66%–85%), 78% (CI 69%–87%) and 76% (CI 67%–86%) respectively (
P = NS vs echocardiography). The sensitivity, specificity and accuracy of echocardiography in detecting peri-infarction ischaemia
for the diagnosis of infarct-related artery stenosis (present in 70 patients) were, rspectively, 77% (CI 68%–86%), 85% (CI
78%–92%) and 79% (CI 70%–87%) while the corresponding figures for
201Tl SPET were 73% (CI 64%–82%), 85% (CI 78%–92%) and 76% (CI 67%–84%) respectively (
P = NS vs echocardiography). The agreement between the two methods for the diagnosis of peri-infarction and remote ischaemia
was 70% (kappa = 0.37) and 80% (kappa = 0.59) respectively. It is concluded that dobutamine stress echocardiography and
201Tl SPET have comparable accuracy for the diagnosis of infarct related and remote CAD in patients with previous myocardial
infarction. The agreement between the methods is higher for the diagnosis of remote CAD than for that of peri-infarction ischaemia.
Received 17 October 1998 and in revised form 5 January 1999
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