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REVIEW ARTICLE

Dobutamine stress myocardial perfusion imaging

^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.

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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