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(Circulation. 1997;96:137-147.)
© 1997 American Heart Association, Inc.
Articles |
Cardiac Imaging for Risk Stratification With Dobutamine-Atropine Stress Testing in Patients With Chest Pain
Echocardiography, Perfusion Scintigraphy, or Both?
From the Thoraxcenter and the Department of Nuclear Medicine, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, Netherlands.
Correspondence to Marcel L. Geleijnse, MD, Thoraxcentre, Ba 300, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.
Background Pharmacological stress echocardiography and myocardial perfusion scintigraphy are used frequently for risk stratification in patients with suspected myocardial ischemia. However, their relative prognostic strength has never been explored.
Methods and Results Two hundred twenty consecutive patients
with chest pain (mean age, 60±12 years; 124 men, 115 with previous
myocardial infarction) were studied with
dobutamine-atropine stress
echocardiography (ECHO) and
simultaneous 99mTc sestamibi single photon
emission computed tomography imaging (MIBI). Ischemia was
defined as deterioration in left ventricular wall motion
and reversible perfusion defects, respectively. ECHO was positive for
ischemia in 76 and MIBI in 91 patients (agreement, 77%;
=.51). During follow-up of 31±15 months, 24 patients had hard
cardiac events (nonfatal myocardial infarction or cardiac death). By
univariate analysis, age, history of congestive
heart failure, and any abnormality or ischemia on ECHO or MIBI
were associated with cardiac events. Multivariate
analysis revealed that age, abnormal ECHO (odds ratio [OR],
18.9; 95% CI, 2.5 to 146.0) or MIBI (OR, 12.8; 95% CI, 1.7 to 98.3),
and ischemia on ECHO (OR, 4.0; 95% CI, 1.6 to 9.9) or MIBI
(OR, 3.0; 95% CI, 1.2 to 7.4) had independent predictive values. When
ECHO was used as a first option, the addition of MIBI to all
nonischemic ECHO studies decreased the OR from 4.0 (95% CI,
1.6 to 9.9) to 3.8 (95% CI, 1.4 to 10.2). Addition of MIBI confined to
nonischemic ECHO studies in which target heart rate was not
attained (nondiagnostic studies) increased the OR to a
maximal 5.7 (95% CI, 2.2 to 15.0). In contrast, the addition of ECHO
to nondiagnostic MIBI studies was not useful.
Conclusions Dobutamine-atropine ECHO and MIBI provide comparable prognostic information. The addition of MIBI to ECHO may be useful in patients with nondiagnostic ECHO studies.
Key Words: stress • tests • echocardiography • radioisotopes • prognosis
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