| Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Clinical Research in Cardiology | ||||
| Publisher: | DR DIETRICH STEINKOPFF VERLAG | ||||
| Place of Publication: | DARMSTADT | ||||
| Volume: | 95 | ||||
| Number of Issue or Book Chapter: | 12 | ||||
| Page Range: | pp. 650-656 | ||||
| Date: | 2006 | ||||
| Institutions: | Medicine > Lehrstuhl für Innere Medizin II Medicine > Abteilung für Nuklearmedizin | ||||
| Identification Number: |
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| Keywords: | CORONARY-ARTERY-DISEASE; LEFT-VENTRICULAR HYPERTROPHY; MYOCARDIAL-PERFUSION; HYPERTENSIVE PATIENTS; SESTAMIBI SPECT; CHEST-PAIN; TOMOGRAPHY; DIAGNOSIS; STENOSIS; EXERCISE; dobutamine; stress-echocardiography; MiBi-SPECT; wall motion abnormalities; perfusion | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 69621 |
Web of ScienceAbstract
Background In the diagnosis of coronary artery disease (CAD) with Dobutamine Stress Echocardiography (DSE), regional wall motion abnormalities (RWMA) are assumed to indicate a perfusion deficit. Methods and results For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone((R)))-enhanced DSE (0-40 mu g/kg Dobutamine, 16-segment- model) and MiBi-SPECT in a ...
Abstract
Background In the diagnosis of coronary artery disease (CAD) with Dobutamine Stress Echocardiography (DSE), regional wall motion abnormalities (RWMA) are assumed to indicate a perfusion deficit. Methods and results For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone((R)))-enhanced DSE (0-40 mu g/kg Dobutamine, 16-segment- model) and MiBi-SPECT in a prospective double-blinded study design in 69 non-selected consecutive patients (44 male, 25 female, age 64 +/- 12 years). Additionally, all patients were examined by coronary-angiography. The prevalence of significant CAD (stenosis > 50% lumen diameter) was 52%. DSE had a sensitivity of 78% and a specificity of 66% for the detection of significant CAD with a positive and negative predictive value of 72 and 73%, respectively. Among 28 patients with significant CAD and positive DSE study (true positive), 78% displayed a corresponding perfusion deficit in MiBi-SPECT. Among 11 patients with a positive DSE study but no current significant coronary stenosis (false positive), 82% showed stress-induced RWMAs in the inferior/ posterior region, 73% displayed left ventricular hypertrophy, 54% resting-ECG abnormalities and 45% resting-RWMA (3 previous MI, 2 previous CABG surgery). Among 8 patients with negative DSE study but significant coronary stenosis (false negative), 75% had a stenosis of the LCX, 63% displayed resting- WMA, 63% displayed left bundle branch block or ST-segment depression, 50% displayed only peripheral coronary stenosis, and DSE visualization was suboptimal in 38%. Conclusion This prospective study in non-selected patients shows that the majority of RWMAs in DSE are matched to a perfusion deficit detectable by nuclear imaging. Nevertheless, pre-existing cardiac abnormalities may also lead to stress-induced RWMA not associated with a perfusion deficit or mask a perfusion deficit upon DSE. Particularly in patients with LV hypertrophy, resting-RWMA, bundle branch block or ST segment depression, the predictive value of DSE may, therefore, be limited.
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