Dobutamin exercise echocardiography versus SPECT in diagnosing ischemic heart disease

Authors: G. Valočik 1;  I. Majerčák 1;  P. Mitro 1;  V. Tóthová 2;  I. Marin 2
Authors‘ workplace: III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura, Košice, Slovenská republika, prednosta doc. MUDr. Peter Mitro, Ph. D. 1;  Inštitút nukleárnej a molekulárnej medicíny Košice, Slovenská republika, riaditeľ MUDr. Igor Marin 2
Published in: Vnitř Lék 2007; 53(12): 1303-1309
Category: Original Contributions


The of the study was comparison of dobutamine stress echocardiography with SPECT in the assessment of ischemic heart disease.

It is a retrospective study analysing 119 patients (72 women and 47 men, mean age 56.9 ± 10.68 years), who underwent dobutamine stress echocardiography and SPECT. Because of inconclusive findings (LBBB, decreased myocardial perfusion by SPECT depending on the position of the body), 23 patients were excluded.

In the whole group of 96 patients the diagnostic validity of dobutamine stress echocardiography was as follows: sensitivity 78 %, specificity 93 %, positive predictive value 89 %, negative predictive value 85 %, and κ value 0.71. In women the sensitivity was 69 %, specificity 93 %, positive predictive value 79 %, negative predictive value 89 %, and κ value 0.64. In men the diagnostic validity was: sensitivity 83 %, specificity 92 %, positive predictive value 95 %, negative predictive value 73 %, and κ value 0.70.

In conclusion, dobutamine stress echocardiography is highly sensitive and specific method in the diagnosis of ischemic heart disease with good agreement when compared with SPECT. Because of availability and lower cost in comparison with SPECT, dobutamine stress echocardiography is an optimal method in the diagnosis and management of patients with ischemic heart disease in routine clinical practice.

Key words:
dobutamine stress echocardiography - SPECT - ischemic heart disease


1. Picano E. Stress Echocardiography: A historical perspective. Am J Medicine 2003; 114: 126-130.

2. Martin TW, Seaworth JF, Johns JP et al. Comparison of adenosine, dipyridamole, and dobutamine stress echocardiography. Ann Intern Med 1992; 116: 190-196.

3. Biagini E, Elhendy A, Bax JJ et al. Seven-year follow-up after dobutamine stress echocardiography: impact of gender on prognosis. J Am Coll Cardiol 2005; 45: 93-97.

4. Cheitlin MD, Armstrong WF, Aurigemma GP et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography). J Am Soc Echocardiogr 2003; 16: 1091-1110.

5. Krivokapich J, Child JS, Walter DO et al. Prognostic value of dobutamine stress echocardiography in predicting cardiac events in patients with known or suspected coronary artery disease. J Am Coll Cardiol 1999; 33: 708-716.

6. Marcovitz PA Prognostic issues in stress echocardiography. Prog Cardiovasc Dis 1997; 39: 533-542.

7. Klocke FJ, Baird MG, Lorell BH et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging - executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003; 108: 1404-1418.

8. Hachamovitch R, Hayes SW, Friedman JD et al. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003; 107: 2900-2907.

9. Shaw LJ, Hachamovitch R, Berman DS et al. for the Economics of Noninvasive Diagnosis (END) Multicenter Study Group. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. J Am Coll Cardiol 1999; 33: 661-669.

10. Weiner DA, Ryan TJ, McCabe CH et al. The role of exercise testing in identifying patients with improved survival after coronary artery bypass surgery. J Am Coll Cardiol 1986; 8: 741-748.

11. Geleijnse ML, Fioretti PM, Roelandt JR et al. Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography. J Am Coll Cardiol 1997; 30: 595-606.

12. Armstrong WF, Pellikka PA, Ryan T et al. Stress echocardiography: recommendations for performance and interpretation of stress echocardiography. Stress Echocardiography Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 1998; 11: 97-104.

13. Farský Š, Lepej J, Bakos K. Nukleárna kardiológia. Martin: Osveta 1989: 269.

14. Lepej J, Farský Š. Táliová scintigrafia myokardu I. Princíp a metodika. Čs Radiol 1990; 44: 171-178.

15. Lepej J, Farský Š. Táliová scintigrafia myokardu II. Hodnotenie výsledkov. Čs Radiol 1990; 44: 179-192.

16. Kamínek M, Mysliveček M, Škvařilová M et al. Correlation of SPECT myocardial stress scintigraphy with coronary angiography. Vnitř Lék 1998; 44: 187-191.

17. Kamínek M, Mysliveček M, Škvařilová M et al. Myocardial perfusion tomography imaging in patients without prior myocardial infarction-comparison between 201Tl, 99mTc-tetrofosmin and dual-isotope protocol (rest 201Tl/stress 99mTc-tetrofosmin). Vnitř Lék 1999; 45: 81-84.

18. Forster T, McNeill AJ, Salustrin A et al. Simultaneous dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 1993; 21: 1591-1596.

19. Huang PJ, Ho YL, Wu CC et al. Simultaneous dobutamine stress echocardiography and thallium-201 perfusion imaging for the detection of coronary artery disease. Cardiology 1997; 88: 556-562.

20. Chae SC, Heo J, Iskandrian AS et al. Identification of extensive coronary artery disease in women by exercise single-photon emission computed tomographic (SPECT) thallium imaging. J Am Coll Cardiol 1993; 21: 1305-1311.

21. Pozzoli MMA, Fioretti PM, Salustri A et al. Exercise echocardiography and technetium-99m MIBI single photon emission computed tomography in the detection of coronary artery disease. Am J Cardiol 1991; 67: 350-355.

22. Quiñones MA, Verani MS, Haichin RM et al. Exercise echocardiography versus 201Tl single-photon emission computed tomography in evaluation of coronary artery disease. Analysis of 292 patients. Circulation 1992; 85: 1026-1031.

23. Takeuchi M, Araki M, Nakashima Z et al. Comparison of dobutamine stress echocardiography and stress thalium-201 single-photon emission computed tomography for detecting coronary artery disease. J Am Soc Echocardiogr 1993; 6: 593-602.

24. Marwick T, D´Hondt AM, Baudhuin T et al. Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography or scintigraphy, or both? J Am Coll Cardiol 1993; 22: 159-167.

25. Salazar HP, Talano J Viable myocardium: How much is enough? A comparison of viability by comparative imaging techniques to assess the quantity and functionality of ischemic myocardium. Echocardiography 2005; 22: 59-70.

26. Baumgarther H, Porenta G, Lau YK et al. Assessment of myocardial viability by dobutamine echocardiography, positron emission tomography and thallium-201 SPECT: Correlation with histopathology in explanted hearts. J Am Coll Cardiol 1998; 32: 1701-1708.

27. Atlantic Information services: Controlling the soaring costs of medical imaging. 15 June 2004.

28. Picano E. Economic and biological costs of cardiac imaging. Cardiovasc Ultrasound 2005; 25: 13.

29. Krenning BJ, Geleijnse ML, Poldermans D et al. Methodological analysis of diagnostic dobutamine stress echocardiography studies. Echocardiography 2004; 21: 725-735.

30. Kaminek M, Indrakova J Quantitative gated SPECT of myocardium in detection of ischemic heart disease: validation of finding by means of coronarography. Biomed. Papers 2003; 147: 243-244.

31. Hirzel HO, Senn M, Nuesch K et al. Thallium-201 scintigraphy in complete left bundle branch block. Am J Cardiol 1984; 53: 764-769.

32. Lepej J, Spišiaková D, Hrnčiar J et al. Táliová SPECT scintigrafia myokardu v hodnotení pacientov so syndrómom inzulínovej rezistencie a mikrovaskulárnou anginou pectoris. Vnitř Lék 2000; 46: 205-212.

33. Kamínek M, Mysliveček M, Škvařilová M et al. Prognostic significance of stress tomographic scintigraphy of myocardial perfusion in diabetic patients. Vnitř Lék 2001;47: 739-743.

34. Kamínek M, Mysliveček M et al. Prognostic value of myocardial perfusion tomographic imaging in patients after percutaneous transluminal coronary angioplasty. Clin Nucl Med 2000; 25: 775-778.

35. Arnett EN, Isner JM, Redwood DR et al. Coronary artery narrowing in coronary artery disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979; 91: 350-356.

36. Leber AW, Knez A, von Ziegler F et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 2005; 46: 147-154.

37. Rodés-Cabau J, Candell-Riera J, Angel J et al. Relation of myocardial perfusion defects and nonsignificant coronary lesions by angiography with insights from intravascular ultrasound and coronary pressure measurements. Am J Cardiol 2005; 96: 1621-1626.

38. Meuwissen M, Chamuleau SAJ, Siebes M et al. Role of variability in microvascular resistance on fractional flow reserve and coronary blood flow velocity reserve in intermediate coronary lesions. Circulation 2001; 103: 184-187.

39. Zeiher AM, Drexler H, Wollschlager H et al. Modulation of coronary vasomotor tone in humans: progressive endothelial dysfunction with different early stages of coronary atherosclerosis. Circulation 1991; 83: 391-401.

40. McLeod AL, Newby DE, Northridge DB et al. Influence of differential vascular remodeling on the coronary vasomotor response. Cardiovasc Res 2003; 59: 520-526.

41. Pulerwitz T, Hirata K, Abe Y et al. Feasibility of using a real-time 3-dimensional technique for contrast dobutamine stress echocardiography. J Am Soc Echocardiogr 2006; 19: 540-545.

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