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

Donald D Miller, Liwa T. Younis, Bernard R. Chaitman, Henry Stratmann

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background. The diagnostic accuracy of exercise 99mTc-labeled sestamibi and intravenous dipyridamole 201Tl-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% (40/43 in patients with single-vessel disease) and 91% (146/161 in patients with multivessel disease). Overall sensitivity was 91%. The specificity was 28% (11/40) 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.

Original languageEnglish (US)
Pages (from-to)18-24
Number of pages7
JournalJournal of Nuclear Cardiology
Volume4
Issue number1 I
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

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Technetium Tc 99m Sestamibi
Dipyridamole
Coronary Artery Disease
Tomography
Exercise
Single-Photon Emission-Computed Tomography
Coronary Stenosis
Coronary Angiography
Stable Angina
Peripheral Vascular Diseases
Cardiac Catheterization
Chest Pain
Population
Coronary Vessels

Keywords

  • Coronary artery disease
  • Diagnostic accuracy
  • Dipyridamole
  • Myocardial perfusion
  • Single-photon emission computed tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Diagnostic accuracy of dipyridamole technetium 99m-labeled sestamibi myocardial tomography for detection of coronary artery disease. / Miller, Donald D; Younis, Liwa T.; Chaitman, Bernard R.; Stratmann, Henry.

In: Journal of Nuclear Cardiology, Vol. 4, No. 1 I, 01.01.1997, p. 18-24.

Research output: Contribution to journalArticle

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abstract = "Background. The diagnostic accuracy of exercise 99mTc-labeled sestamibi and intravenous dipyridamole 201Tl-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{\%} (40/43 in patients with single-vessel disease) and 91{\%} (146/161 in patients with multivessel disease). Overall sensitivity was 91{\%}. The specificity was 28{\%} (11/40) 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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AU - Stratmann, Henry

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N2 - Background. The diagnostic accuracy of exercise 99mTc-labeled sestamibi and intravenous dipyridamole 201Tl-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% (40/43 in patients with single-vessel disease) and 91% (146/161 in patients with multivessel disease). Overall sensitivity was 91%. The specificity was 28% (11/40) 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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KW - Coronary artery disease

KW - Diagnostic accuracy

KW - Dipyridamole

KW - Myocardial perfusion

KW - Single-photon emission computed tomography

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