CLINICAL STUDIES
Comparison of stress/rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test
Gabriele Fragasso, MDa,
Chunzeng Lu, MDa,
Pawel Dabrowski, MDa,
Paolo Pagnotta, MDa,
Imad Sheiban, MDa and
Sergio L. Chierchia, MD, FESC, FACCa
a Divisione di Cardiologia, Istituto Scientifico H San Raffaele, Milan, Italy
Manuscript received October 26, 1998;
revised manuscript received March 6, 1999,
accepted April 30, 1999.
Reprint requests and correspondence: Dr. Gabriele Fragasso, Istituto Scientifico H San Raffaele, Divisione di Cardiologia, Via Olgettina, 60, 20132 Milan, Italy
fragasso.gabriele{at}hsr.it
OBJECTIVES
Although different noninvasive tests have been proposed for detecting coronary artery disease (CAD) in patients with hypertension and chest pain symptoms, the relative performance of the available techniques has not been systematically assessed.
BACKGROUND
Patients with hypertension frequently complain of chest pain and exhibit ischemic-like ST segment changes on the exercise electrocardiogram (ECG). However, the specificity of such changes for predicting significant CAD is very low, because these patients often exhibit a normal coronary angiogram.
METHODS
In 101 patients with hypertension, chest pain and positive exercise ECG, we performed stress/rest myocardial single photon emission computed tomography with 99mTc-MIBI, dipyridamole and dobutamine stress echocardiography and coronary angiography. All patients had normal global ventricular function and 57 had left ventricular hypertrophy. All were kept on ACE inhibitors during the study period.
RESULTS
No patients had significant side effects during perfusion scintigraphy. Dose-limiting side effects were observed in five patients with dipyridamole and in seven patients with dobutamine. Only 56% of study patients exhibited significant CAD. Sensitivity, specificity, accuracy, positive and negative predictive values were, respectively, 98%, 36%, 71%, 67% and 94% for perfusion scintigraphy, 61%, 91%, 74%, 90% and 64% for dipyridamole and 88%, 80%, 84%, 85% and 83% for dobutamine stress echocardiography.
CONCLUSIONS
This study shows that stress echo in patients with hypertension yields a satisfactory diagnostic accuracy for identifying significant epicardial CAD. Our results indicate that dobutamine might be superior to dipyridamole. The low specificity of myocardial scintigraphy probably relates to the fact that this method traces perfusion abnormalities, not necessarily caused by epicardial CAD, possibly due to microvascular disease and not causing obvious wall motion abnormalities.
|
Abbreviations and Acronyms
| | ATP | = adenosine triphosphate | | CAD | = coronary artery disease | | ECG | = electrocardiogram | | LVMI | = left ventricular mass index | | MIBI | = methoxy-isobutyl-isonitrile | | RPP | = rate-pressure product | | SPECT | = single photon emission computed tomography |
|
This article has been cited by other articles:
|
|
|
|
 
U. Hoffmann, F. Bamberg, C. U. Chae, J. H. Nichols, I. S. Rogers, S. K. Seneviratne, Q. A. Truong, R. C. Cury, S. Abbara, M. D. Shapiro, et al.
Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial.
J. Am. Coll. Cardiol.,
May 5, 2009;
53(18):
1642 - 1650.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. C. Hendel
Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department: Antagonist Viewpoint
Circ Cardiovasc Imaging,
May 1, 2009;
2(3):
264 - 275.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. W. McIntyre, S. G. John, and H. J. Jefferies
Advances in the cardiovascular assessment of patients with chronic kidney disease
NDT Plus,
December 1, 2008;
1(6):
383 - 391.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E. Karagiannis, H. H.H. Feringa, A. Elhendy, R. van Domburg, M. Chonchol, R. Vidakovic, J. J. Bax, G. Karatasakis, G. Athanasopoulos, D. V. Cokkinos, et al.
Prognostic significance of renal function in patients undergoing dobutamine stress echocardiography
Nephrol. Dial. Transplant.,
February 1, 2008;
23(2):
601 - 607.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Hoffmann, J. T. Nagurney, F. Moselewski, A. Pena, M. Ferencik, C. U. Chae, R. C. Cury, J. Butler, S. Abbara, D. F. Brown, et al.
Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain
Circulation,
November 21, 2006;
114(21):
2251 - 2260.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Sharma, D. Pellerin, D.C. Gaze, J.S. Shah, C.P. Streather, P.O. Collinson, and S.J. Brecker
Dobutamine stress echocardiography and cardiac troponin T for the detection of significant coronary artery disease and predicting outcome in renal transplant candidates
Eur J Echocardiogr,
October 1, 2005;
6(5):
327 - 335.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Paetsch, C. Jahnke, A. Wahl, R. Gebker, M. Neuss, E. Fleck, and E. Nagel
Comparison of Dobutamine Stress Magnetic Resonance, Adenosine Stress Magnetic Resonance, and Adenosine Stress Magnetic Resonance Perfusion
Circulation,
August 17, 2004;
110(7):
835 - 842.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C Y Loong and C Anagnostopoulos
Diagnosis of coronary artery disease by radionuclide myocardial perfusion imaging
Heart,
August 1, 2004;
90(suppl_5):
v2 - v9.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Houghton, D. S. Strogatz, M. T. Torosoff, V. E. Smith, S. A. Fein, P. A. Kuhner, E. F. Philbin, and A. A. Carr
African Americans With LVH Demonstrate Depressed Sensitivity of the Coronary Microcirculation to Stimulated Relaxation
Hypertension,
September 1, 2003;
42(3):
269 - 276.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A.F.L Schinkel, J.J Bax, M.L Geleijnse, E Boersma, A Elhendy, J.R.T.C Roelandt, and D Poldermans
Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?
Eur. Heart J.,
May 1, 2003;
24(9):
789 - 800.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Boon, J. van Goudoever, J. J. Piek, and G. A. van Montfrans
ST Segment Depression Criteria and the Prevalence of Silent Cardiac Ischemia in Hypertensives
Hypertension,
March 1, 2003;
41(3):
476 - 481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Elhendy, K. M. Modesto, D. W. Mahoney, B. K. Khandheria, J. B. Seward, and P. A. Pellikka
Prediction of mortality in patients with left ventricular hypertrophy by clinical, exercise stress, and echocardiographic data
J. Am. Coll. Cardiol.,
January 1, 2003;
41(1):
129 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H Marwick
Stress echocardiography
Heart,
January 1, 2003;
89(1):
113 - 118.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Elhendy, J. J. Bax, and D. Poldermans
Dobutamine Stress Myocardial Perfusion Imaging in Coronary Artery Disease
J. Nucl. Med.,
December 1, 2002;
43(12):
1634 - 1646.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H. Marwick, C. Case, S. Sawada, C. Vasey, and J. D. Thomas
Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease
Hypertension,
June 1, 2002;
39(6):
1113 - 1118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Elhendy, R T van Domburg, F B Sozzi, D Poldermans, J J Bax, and J R T C Roelandt
Impact of hypertension on the accuracy of exercise stress myocardial perfusion imaging for the diagnosis of coronary artery disease
Heart,
June 1, 2001;
85(6):
655 - 661.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
R. Haberl, A. Becker, A. Leber, A. Knez, C. Becker, C. Lang, R. Bruning, M. Reiser, and G. Steinbeck
Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients
J. Am. Coll. Cardiol.,
February 1, 2001;
37(2):
451 - 457.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Varga
Pharmacologic stress echocardiography: can we forget "state-of-the-art" protocols?
J. Am. Coll. Cardiol.,
June 1, 2000;
35(7):
1994 - 1995.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Fragasso
Reply
J. Am. Coll. Cardiol.,
June 1, 2000;
35(7):
1995 - 1995.
[Full Text]
[PDF]
|
|
|
|
