Exercise Echocardiography and Technetium-99m MIBI Single-Photon Emission Computed Tomography in the Detection of Coronary Artery Disease Massimo M. A. Pozzoli, MD, Paolo M. Fioretti, MD, PhD, Alessandro Salustri, MD, Ambroos E. M. Reijs, MSc, and Jos R. T. C. Roelandt, MD
To compare the relative diagnostic value of exercise echocardiography with perfusion technetiumSSm metoxyisobutylisonitrile single-photon emission computed tomography (SPECT) in detecting coronary artery disease (CAD), 75 patients with suspected CAD but a normal electrocardiogram (ECG) at rest were included in a prospective correlative study. Both the exercise echocardlograms and SPECT studies were performed in conjunction with the same symptom-limited bicycle exercise test. The development of either a new wall motion abnormality or a reversible perfusion defect after exercise, or both, were regarded as a positive test for the exercise echocardiographic and SPECT studies, respectively. The results of these 2 diagnostic tests were compared with coronary arteriography. Exercise echocardiography identified 35 (71%) and SPEW 41 (64%, p = 0.13) of the 49 patients with significant CAD (defined as >SO% diameter stenosis). Twenty-five of the 26 patients (96%) without significant coronary stenosis had negative exercise echocardiographic results and 23 of 26 (66%) had negative SPECT results. Exercise-induced new wall motion abnormalities showed a good correlation with reversible perfusion defects, and the results of the 2 methods were concordant in 65 of 75 patients (agreement = 66%, K = 0.75 f 0.14). Both the diagnostic accuracy of exercise echocardiography and SPECT were significantly higher than the exercise ECG (81 vs 64% p < 0.02 and 68 vs 64%, p < 0.005). The sensitivity and specificity for detecting individual diseased vessels were 60 and 95% for exercise echocardiography and 67 and 94% for SPECT. However, in the 33 patients with l-vessel disease, exercise echocardiography showed a lower sensitivity when comFrom the Thoraxcentre, Department of Cardiology, and the Department of Nuclear Medicine, Dijkzigt University Hospital and Erasmus University, Rotterdam, and the Interuniversity Cardiology Institute of The Netherlands. Dr. Pozzoli was supported in part by Fondazione Clinica de1 Lavoro, Centro Medico di Montescano, Pavia, Italy. Dr. Salustri was the recipient of Grant 5442 from the Interuniversity Cardiology Institute of The Netherlands, Rotterdam, The Netherlands. Manuscript received August 9,199O; revised manuscript received October 6, 1990, and accepted October 9. Address for reprints: Paolo Fioretti, MD, Thoraxcenter, Ba 300, Erasmus University, P.O. Box 1738,300O DR Rotterdam, The Netherlands.
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pared with SPECT (61 vs 82%, p 50% diameter stenosis of 2 1 of the coronary arteries; of these, 16 had a.multiple vesseldisease.Twenty-six had either normal or not significantly diseasedvessels.
l-vessel disease, SPECT showed a greater sensitivity than exercise echocardiography (p
To compare the relative diagnostic value of exercise echocardiography with perfusion technetiumSSm metoxyisobutylisonitrile single-photon emission computed tomography (SPECT) in detecting coronary artery disease (CAD), 75 patients with suspected CAD but a normal electrocardiogram (ECG) at rest were included in a prospective correlative study. Both the exercise echocardlograms and SPECT studies were performed in conjunction with the same symptom-limited bicycle exercise test. The development of either a new wall motion abnormality or a reversible perfusion defect after exercise, or both, were regarded as a positive test for the exercise echocardiographic and SPECT studies, respectively. The results of these 2 diagnostic tests were compared with coronary arteriography. Exercise echocardiography identified 35 (71%) and SPEW 41 (64%, p = 0.13) of the 49 patients with significant CAD (defined as >SO% diameter stenosis). Twenty-five of the 26 patients (96%) without significant coronary stenosis had negative exercise echocardiographic results and 23 of 26 (66%) had negative SPECT results. Exercise-induced new wall motion abnormalities showed a good correlation with reversible perfusion defects, and the results of the 2 methods were concordant in 65 of 75 patients (agreement = 66%, K = 0.75 f 0.14). Both the diagnostic accuracy of exercise echocardiography and SPECT were significantly higher than the exercise ECG (81 vs 64% p < 0.02 and 68 vs 64%, p < 0.005). The sensitivity and specificity for detecting individual diseased vessels were 60 and 95% for exercise echocardiography and 67 and 94% for SPECT. However, in the 33 patients with l-vessel disease, exercise echocardiography showed a lower sensitivity when comFrom the Thoraxcentre, Department of Cardiology, and the Department of Nuclear Medicine, Dijkzigt University Hospital and Erasmus University, Rotterdam, and the Interuniversity Cardiology Institute of The Netherlands. Dr. Pozzoli was supported in part by Fondazione Clinica de1 Lavoro, Centro Medico di Montescano, Pavia, Italy. Dr. Salustri was the recipient of Grant 5442 from the Interuniversity Cardiology Institute of The Netherlands, Rotterdam, The Netherlands. Manuscript received August 9,199O; revised manuscript received October 6, 1990, and accepted October 9. Address for reprints: Paolo Fioretti, MD, Thoraxcenter, Ba 300, Erasmus University, P.O. Box 1738,300O DR Rotterdam, The Netherlands.
350
THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 67
pared with SPECT (61 vs 82%, p 50% diameter stenosis of 2 1 of the coronary arteries; of these, 16 had a.multiple vesseldisease.Twenty-six had either normal or not significantly diseasedvessels.
l-vessel disease, SPECT showed a greater sensitivity than exercise echocardiography (p
