Dobutamine thallium-201 SPECT imaging for assessment of peri-infarction and remote myocardial ischemia.

Abstract

This study assessed the value of dobutamine 201Tl scintigraphy for detecting significant disease of infarct-related and remote coronary arteries in myocardial infarction patients. Dobutamine (up to 40 micrograms/kg/min)/atropine (up to 1 mg) stress test in conjunction with stress-reinjection 200Tl SPECT was performed in 71 symptomatic patients with left ventricular dysfunction > 3 mo after myocardial infarction. Ischemia was defined as reversible perfusion defects. Significant coronary artery stenosis (> or = 50% luminal diameter stenosis) was detected in all patients. Sensitivity, specificity and accuracy of regional ischemia for the diagnosis of remote coronary artery stenosis were 74% (95% Cl 63-86), 80% (Cl 70-90) and 76% (Cl 65-87), respectively. Those for infarct-related artery stenosis were 71% (Cl 60-81), 83% (Cl 75-92) and 72% (Cl 61-82), respectively. Ischemic perfusion score was higher in patients with multiversus single-vessel disease (1056 +/- 1021 versus 423 +/- 633, p < 0.01). Dobutamine thallium scintigraphy is valuable for assessing the extent of coronary stenosis on the basis of reversible hypoperfusion in symptomatic patients late after myocardial infarction.