Dobutamine stress myocardial function versus nuclear perfusion imaging

Confirming or excluding coronary artery disease in patients with chest pain remains a challenge because this disease is still the leading cause of death in the Western world (I). Traditionally, exercise electrocardiography is perfomled as a first-line noninvasive diagnostic stress test (2). However, a substantial number of patients referred for evaluation of chest pain are unable to perform adequate exercise testing, mainly because of decollditioning or neurologic, respiratory, peripheral vascular, or orthopedic limitations (3). In these patients, dobutamine stress represents an alternative, exercise independent stress technique. Usually, this fann of stress is combined with two-dimensional echocardiography, providing functional data on myocardial wall thickening (4), or nuclear perfusion imaging, providing data on myocardial perfusion (5). Despite the increasing number of dobutamine tests performed each year, little is known about the relative diagnostic and prognostic value of the two imaging modalities. In this thesis, a comparison between dobutamine stress echocardiography and teclmetium-99m single-photon emission computed tomographic imaging is presented. Part A of the thesis deals with the methodology of dobutamine stress testing and the respective benefits of dobutamine stress echocardiography and technetium-99m perfusion imaging (chapters I to 3). In part B the diagnostic merits of the two stress modalities in patients with suspected coronary artery disease (chapter 4), prior myocardial infarction (chapter 5), left ventricular hypertrophy (chapter 6), and left bundle branch block (chapters 7 and 8) are discussed. Part C of the thesis discusses the prognostic merits of the stress modalities in patients with stable (chapters 9 to II) and suspected unstable chest pain syndromes (chapter 12).

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