Document Detail


Dobutamine-atropine stress myocardial perfusion SPECT imaging in the diagnosis of graft stenosis after coronary artery bypass grafting.
MedLine Citation:
PMID:  9796896     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the accuracy of dobutamine stress myocardial perfusion single photon emission computed tomographic imaging (SPECT) for the diagnosis of vascular stenosis after coronary artery bypass grafting (CABG). BACKGROUND: Exercise thallium scintigraphy is a clinically useful method for the diagnosis of graft stenosis after CABG. Although dobutamine perfusion scintigraphy is an alternative method for the evaluation of patients with limited exercise capacity, its value in the diagnosis of vascular stenosis after CABG has not been studied. METHODS: Dobutamine (up to 40 lg/kg/min)-atropine (up to 1 mg) stress test in conjunction with myocardial perfusion SPECT imaging (201T1 or 99m technetium sestamibi [MIBII) was performed in 71 patients (mean age 58 9 years, 57 men) with limited exercise capacity referred for evaluation of myocardial ischemia 3.7 3.5 years after CABG. Significant vascular stenosis was defined as >50% luminal diameter stenosis of a graft or a native nongrafted coronary artery and was predicted on the basis of reversible perfusion abnormalities. RESULTS: Significant vascular stenosis was detected in 52 patients. Sensitivity, specificity, and accuracy of reversible perfusion defects at dobutamine SPECT for the overall diagnosis of vascular stenosis were 81%, confidence interval (CI) 72 to 90, 79%, CI 69 to 88, and 80%, CI 71 to 90, respectively. Significant vascular stenosis was detected in 73 arterial regions. Sensitivity, specificity, and accuracy of dobutamine SPECT for the diagnosis of regional vascular stenosis were 66%, CI 58 to 74, 83%, CI 76 to 89, and 74%, CI 67 to 81, respectively. Patients with multivessel stenosis had a higher number of ischemic segments (1.6 + 1.3 vs 1 + 1, P < .05) and ischemic perfusion score (3.2 2.7 vs 2.2 + 2.3, P < .05) than patients with single-vessel stenosis, respectively. Significant graft stenosis was detected in 67 graft regions. Sensitivity, specificity, and accuracy of dobutamine SPECT for the diagnosis of regional graft stenosis were 64%, CI 56 to 73, 85%, CI 78 to 91, and 74%, CI 66 to 82, respectively. CONCLUSION: Dobutamine stress myocardial perfusion SPECT imaging is a useful method for the diagnosis of significant vascular stenosis after CABG in patients with limited exercise capacity.
Authors:
A Elhendy; R T van Domburg; J J Bax; P R Nierop; R Valkema; M L Geleijnse; J D Kasprzak; A F Liqui-Lung; J H Cornel; J R Roelandt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  5     ISSN:  1071-3581     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    1998 Sep-Oct
Date Detail:
Created Date:  1999-01-07     Completed Date:  1999-01-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  491-7     Citation Subset:  IM    
Affiliation:
Thoraxcenter and the Department of Nuclear Medicine, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Atropine / diagnostic use*
Coronary Angiography
Coronary Artery Bypass*
Coronary Disease / radionuclide imaging*
Dobutamine / diagnostic use*
Electrocardiography
Female
Heart / radionuclide imaging*
Hemodynamics / drug effects
Humans
Male
Middle Aged
Tomography, Emission-Computed, Single-Photon*
Chemical
Reg. No./Substance:
34368-04-2/Dobutamine; 51-55-8/Atropine
Comments/Corrections
Comment In:
J Nucl Cardiol. 1998 Sep-Oct;5(5):533-7   [PMID:  9796901 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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