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Value of Dobutamine Technetium-99m-Sestamibi SPECT and Echocardiography in the Detection of Coronary Artery Disease Compared with Coronary Angiography

Bengül Günalp, Barbaros Dokumaci, Changr Uyan, Erkan Vardarel, Ersoy Iik, Hkmet Bayhan, Mehmet Özgüven and Emel Öztürk

Departments of Nuclear Medicine and Cardiology, Gülhane Military Medical Academy and Faculty, Ankara, Turkey

Correspondence: For correspondence or reprints contact: Bengül Günalp, MD, Gülhane Askeri Tip Akademisi, Nükleer Tip Anabilim Dali, 06018 Etlik Ankara, Turkey.

ABSTRACT

The value of dobutamine echocardiography and ^99mTc-sestamibi SPECT imaging was evaluated as a noninvasive diagnostic method for assessing coronary artery disease (CAD).Twenty-seven patients who underwent coronary angiography were submitted to two separate injections of ^99mTc-sestamibi, one under control conditions and the other after reaching a peak dobutamine infusion rate. Simultaneous ECG and echocardiographic monitoring was also performed during stepwise dobutamine infusion. Whereas the overall sensitivity and specificity of dobutamine sestamibi SPECT imaging were 94% and 88%, these values for dobutamine ECG and echocardiography were 61%, 55% and 84%, 88%, respectively. When dobutamine echocardiography and ^99mTc-sestamibi SPECT imaging were evaluated together, the diagnostic accuracy reaches almost 100%. Dobutamine echocardiography is of value in determining ischemic threshold earlier than clinical symptoms and allows simultaneous evaluation of ventricular performance and contractile function associated with perfusion abnormalities on ^99mTc-sestamibi SPECT imaging. Our experience shows that ^99mTc-sestamibi SPECT imaging, when combined with dobutamine echocardiography, is a safe, practical, well tolerated method with high diagnostic accuracy for the evaluation of CAD.

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