REVIEW ARTICLE
Dobutamine stress myocardial perfusion imaging
Marcel L. Geleijnse, MD, PhDa,
Abdou Elhendy, MD, PhDa,
Paolo M. Fioretti, MD, PhD, FACCa and
Jos R. T. C. Roelandt, MD, PhD, FACCa
a Thoraxcenter Rotterdam, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands
Manuscript received January 13, 2000;
revised manuscript received June 27, 2000,
accepted August 16, 2000.
Reprint requests and correspondence: Marcel L. Geleijnse, MD, Thoraxcenter, Ba 302, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
ml.geleijnse{at}worldonline.nl
In patients with limited exercise capacity and (relative) contraindications to direct vasodilators such as dipyridamole or adenosine, dobutamine stress nuclear myocardial perfusion imaging (DSMPI) represents an alternative, exercise-independent stress modality for the detection of coronary artery disease (CAD). Nondiagnostic test results (absence of reversible perfusion defects with submaximal stress) do occur in approximately 10% of patients. Serious side effects during DSMPI are rare, with no death, myocardial infarction or ventricular fibrillation reported in three DSMPI safety reports for a total of 2,574 patients. On the basis of a total number of 1,014 patients reported in 20 studies, the sensitivity, specificity and accuracy of the test for the detection of CAD were 88%, 74% and 84%, respectively. Mean sensitivities for one-, two- and three-vessel disease were 84%, 95% and 100%, respectively. The sensitivity for detection of left circumflex CAD (50%) was lower, compared with that for left anterior descending CAD (68%) and right CAD (88%). The sensitivity of predicting multivessel disease by multiregion perfusion abnormalities varied widely, from 44% to 89%, although specificity was excellent in all studies (89% to 94%). In direct diagnostic comparisons, DSMPI was more sensitive, but less specific, than dobutamine stress echocardiography and comparable with direct vasodilator myocardial perfusion imaging. In the largest prognostic study, patients with a normal DSMPI study had an annual hard event rate less than 1%. An ischemic scan pattern provided independent prognostic value, with a direct relationship between the extent and severity of the perfusion defects and prognosis. In conclusion, DSMPI seems a safe and useful nonexercise-dependent stress modality to detect CAD and assess prognosis.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | CI | = confidence interval | | DSE | = dobutamine stress echocardiography | | DSMPI | = dobutamine stress myocardial perfusion imaging | | ECG | = electrocardiogram or electrocardiographic | | LBBB | = left bundle branch block | | LVH | = left ventricular hypertrophy | | MI | = myocardial infarction | | MPI | = myocardial perfusion imaging |
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