Diagnostic accuracy of dipyridamole technetium 99m-labeled sestamibi myocardial tomography for detection of coronary artery disease

doi:10.1016/S1071-3581(97)90045-3

Journal of Nuclear Cardiology

Volume 4, Issue 1, Part 1, January–February 1997, Pages 18-24

https://doi.org/10.1016/S1071-3581(97)90045-3 Get rights and content

Abstract

Background. The diagnostic accuracy of exercise ^99mTc-labeled sestamibi and intravenous dipyridamole ²⁰¹T1-labeled myocardial tomography is established. The accuracy of dipyridamole stress ^99mTc-labeled sestamibi myocardial tomography for the detection of coronary artery disease has not been reported.

Methods and Results. Our purpose was to determine the diagnostic accuracy of same-day, rest-dipyridamole stress ^99mTc-labeled sestamibi myocardial single-photon emission computed tomography (SPECT) compared with coronary angiography. Two hundred forty-four patients who were unable to exercise adequately underwent both dipyridamole ^99mTc-labeled sestamibi SPECT and coronary angiography within 6 months. Dipyridamole was administered intravenously in a standard dose of 0.56 mg/kg for 4 minutes. Cardiac and noncardiac side effects were recorded. The presence of coronary stenoses of 50% or greater diameter reduction in each of the major coronary arteries was compared with imaging data in corresponding myocardial perfusion beds. The patient population was predominately (98.8%) male with a mean age of 63 ± 9 years (range 33 to 83 years). The majority of patients had stable angina (88%). Eighty-four patients (35%) gave a prior history of myocardial infarction; 44 patients (18%) had a history of congestire heart failure. The principal limitation to exercise stress was peripheral vascular disease in 62 patients (26%). No serious side effects occurred during dipyridamole stress; 14% of patients had chest pain and 8% of patients had 1 mm or greater ST segment depression. Of the 204 patients with documented coronary stenoses, 43 (21%) had single-vessel disease and 161 (79%) had multivessel disease. The sensitivity was 93% ( $4043$ in patients with single-vessel disease) and 91% ( $146161$ in patients with multivessel disease). Overall sensitivity was 91%. The specificity was 28% ( $1140$ ) in this population with a high prestest probability of coronary artery disease and posttest referral for cardiac catheterization.

Conclusion. ^99mTc-labeled sestamibi myocardial tomography in conjunction with intravenous dipyridamole stress is a safe and sensitive method for the detection of coronary artery disease. The diagnostic accuracy of dipyridamole stress ^99mTc-labeled sestamibi SPECT for the detection of coronary artery disease is similar to that reported for exercise stress ^99mTc-labeled sestamibi tomography, making this a suitable alternative for the evaluation of patients who are unable to exercise adequately.

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^☆: Supported in part by DuPont Merck Radiopharmaceutical Co., North Billerica, Mass.

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Original articleDiagnostic accuracy of dipyridamole technetium 99m-labeled sestamibi myocardial tomography for detection of coronary artery disease☆

Abstract

J Am Coll Cardiol

Int J Cardiol

Am Heart J

Am J Cardiol

Cardiol Clin North Am

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Original article
Diagnostic accuracy of dipyridamole technetium 99m-labeled sestamibi myocardial tomography for detection of coronary artery disease☆