Heart 1998;79:274-280 ( March )
Assessment of myocardial perfusion and contractile function by inotropic stress Tc-99m sestamibi SPECT imaging and echocardiography for optimal detection of multivessel coronary artery disease
Department of Cardiovascular Medicine, Northwick
Park and St Mark's Hospitals NHS Trust and Institute of Medical
Research, Watford Road, Harrow, Middlesex
HA1 3UJ, UK
Correspondence to: Dr Lahiri.
Accepted for publication 3 November 1997
Objective
To assess whether inotropic
stress myocardial perfusion imaging, echocardiography, or a combination
of the two could enhance the detection of multivessel disease, over and
above clinical and exercise electrocardiographic data.
Design100 consecutive patients investigated by
exercise electrocardiography and diagnostic coronary arteriography
underwent simultaneous inotropic stress Tc-99m sestamibi SPECT (MIBI)
imaging and echocardiography. MIBI imaging and echocardiographic data
were analysed using a 12 segment left ventricular model, and each
segment was ascribed to a particular coronary artery territory. The
presence of perfusion defects with MIBI imaging or of wall thickening
abnormality with echocardiography in at least two coronary artery
territories at peak stress was taken as diagnostic of multivessel
disease. Arteriographic evidence of 
50% stenosis was considered significant.
Results56 patients had multivessel
disease. The sensitivity of the combination of MIBI imaging and
echocardiography for detecting this was greater than either MIBI
imaging or echocardiography alone (82%, 68%, and 68%, respectively;
p = 0.005). Clinical and exercise electrocardiographic variables gave
an R2 value of 18.2% for predicting
multivessel disease. The addition of either MIBI imaging
(R2 = 29.2%; p = 0.002) or
echocardiography (R2 = 28.8%; p < 0.001)
enhanced the detection of multivessel disease, and the inclusion of
both had further incremental value
(R2 = 34.8%; p = 0.003). Age
(p = 0.03), MIBI imaging (p = 0.007), and echocardiography
(p = 0.001) were independent predictors of multivessel disease.
ConclusionsThe assessment of both
myocardial perfusion and contractile function by simultaneous inotropic
stress MIBI imaging and echocardiography optimises the non-invasive
detection of multivessel disease.
© 1998 by Heart
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