Comparison of dobutamine stress echocardiography and 99m-technetium sestamibi SPECT myocardial perfusion scintigraphy for predicting extent of coronary artery disease in patients with healed myocardial infarction.

This study compares the value of dobutamine stress echocardiography and 99m-technetium methoxyisobutyl-isonitrile (MIBI) single-photon emission computed tomography (SPECT) in the assessment of extent and location of coronary narrowing in patients with healed myocardial infarction. Dobutamine (up to 40 microg/kg/ min)-atropine (up to 1 mg) stress echocardiography (DSE) in conjunction with MIBI SPECT was performed in 72 patients (52 men, mean age 57 +/- 11 years) with healed myocardial infarction referred for evaluation of myocardial ischemia. Ischemia was defined as new or worsened wall motion abnormalities at DSE and reversible perfusion defects at MIBI SPECT. Significant stenosis (> or = 50% luminal diameter stenosis) of the infarct-related artery was detected in 45 patients and of other coronary arteries in 22 patients. Sensitivity and specificity of remote ischemia for diagnosis of remote coronary stenosis were 68% (95% confidence interval [CI] 57 to 80) and 93% (CI 86 to 99) for DSE, and 64% (CI 52 to 76), and 90% (CI 83 to 98) for MIBI SPECT, respectively. The positive predictive value and specificity of peri-infarction ischemia for the diagnosis of infarct-related artery stenosis were 89% (CI 81 to 97) and 82% (CI 73 to 92) for DSE, and 87% (CI 79 to 95) and 82% (CI 73 to 92) for SPECT, respectively. The agreement between both techniques was higher for the diagnosis of remote than peri-infarction ischemia (84% vs 66%, p = 0.02). It is concluded that in patients with myocardial infarction undergoing dobutamine stress testing, both echocardiography and MIBI SPECT are clinically useful methods for the diagnosis of remote and infarct-related coronary artery stenosis.