Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography

Summary

Aim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutami-ne-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-seg-ment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modeli. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis >50%.) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. Eor dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.

Zusammenfassung

Ziel: Die Stress-Echokardiographie hat zunehmende Verbreitung zur Ischämiediagnostik bei Patienten mit koronarer Herzerkrankung (KHK) gefunden. 10 bis 15% der Patienten, die einer Stress-Echokardiographie zugeführt werden, haben jedoch ein unzureichendes Schallfenster. Deshalb sollten Dobutamin-Stress-Magnetresonanztomogra-phie (Dobutamin« und Dipyridamol-TI-201-SPECT (Dipyridamol-SPECT) als alternative Strategien der Ischämiediagnostik verglichen werden. Patienten und Methoden: Von 296 konsekutiven Patienten, die einer Stress-Echokardiographie zugeführt wurden, waren bei 45 Patienten (15%) mindestens zwei Wandsegmente nach dem 16-Segment-Modell der American Society of Echocardiography nicht beurteilbar. Sie wurden einer Dobutamin-MRT und einer Dipyridamol-SPECT zugeführt und zum Vergleich nach einem 28-Segment-Modell ausgewertet. Die Myokardseg-mente wurden den Versorgungsgebieten der Koronargefäße zugeordnet und die Ergebnisse der Ischämiediagnostik mit denen der Koronarangiographie (Stenose >50%) verglichen. Ergebnisse: Im Vergleich zur Koronarangiographie ergab sich für die Dobutamin-MRT eine Sensilivität von 87%, eine Spezifität von 86%, ein positiver Vorhersagewert von 93%, ein negativer Vorhersagewert von 75% und eine diagnostische Genauigkeit von 86%. Für die Dipyridamol-SPECT betrugen die jeweiligen Werte 90%, 86%, 93%, 80% und 89%. Diese Werte zeigten keinen signifikanten Unterschied. Schlussfolgerungen: Bei Patienten mit schlechten echokardiographischen Schallbedingungen sind Dobutamin-MRT und Dipyridamol-SPECT geeignete Verfahren zur Ischämiediagnostik. Die Auswahl ist vom Patienten, von technischen Faktoren, der örtlichen Logistik und der Erfahrung des Untersuchers abhängig.

Keywords

Coronary artery disease - stress-echocardiography - magnetic resonance imaging - myocardial scintigraphy - T1-201 -SPECT - pharmacological stress testing

Schlüsselwörter

Koronare Herzerkrankung (KHK) - Stress-Echokardio-graphie - Magnetresonanztomographie - Myokardszintigraphie - T1-201-SPECT - pharmakologische Stressuntersuchungen

^* Klinik III für Innere Medizin, Universität zu Köln

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