CLINICAL STUDY: STRESS TESTING
Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: limitations and concordance
Steven C. Smart, MD, FACC*,
Aneeta Bhatia, MD ,
Robert Hellman, MD ,
Thomas Stoiber, MD, FACC,
Arthur Krasnow, MD,
B. David Collier, MD and
Kiran B. Sagar, MD, FACC
* Division of Cardiology, Gundersen Lutheran, La Crosse, Wisconsin, USA
Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Division of Nuclear Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Manuscript received May 26, 1998;
revised manuscript received March 21, 2000,
accepted May 1, 2000.
Reprint requests and correspondence: Dr. Steven C. Smart, Gundersen Lutheran, Division of Cardiology, University of Wisconsin, 1836 South Avenue, La Crosse, Wisconsin 54601
scsmart{at}gundluth.org
OBJECTIVES
We sought to compare dobutamine-atropine stress echocardiography (DASE) and dipyridamole Technetium 99-m (Tc-99m) sestamibi single photon emission computed tomography (SPECT) scintigraphy (DMIBI) for detecting coronary artery disease (CAD).
BACKGROUND
Both DASE and DMIBI are effective for evaluating patients for CAD, but their concordance and limitations have not been directly compared.
METHODS
To investigate these aims, patients underwent multistage DASE, DMIBI and coronary angiography within three months. Dobutamine-atropine stress echocardiography and stress-rest DMIBI were performed according to standard techniques and analyzed for their accuracy in predicting the extent of CAD. Segments were assigned to vascular territories according to standard models. Angiography was performed using the Judkin’s technique.
RESULTS
The 183 patients (mean age: 60 ± 11 years, including 50 women) consisted of 64 patients with no coronary disease and 61 with single-, 40 with two- and 18 with three-vessel coronary disease. Dobutamine-atropine stress echocardiography and DMIBI were similarly sensitive (87%, 104/119 and 80%, 95/119, respectively) for the detection of CAD, but DASE was more specific (91%, 58/64 vs. 73%, 47/64, p < 0.01). Sensitivity was similar for the detection of CAD in patients with single-vessel disease (84%, 51/61 vs. 74%, 45/61, respectively) and multivessel disease (91%, 53/58 vs. 86%, 50/58, respectively). Multiple wall motion abnormalities and perfusion defects were similarly sensitive for multivessel disease (72%, 42/58 vs. 66%, 38/53, respectively), but, again, DASE was more specific than DMIBI (95%, 119/125 vs. 76%, 95/125, respectively, p < 0.01). Dobutamine-atropine stress echocardiography and DMIBI were moderately concordant for the detection and extent of CAD (Kappa 0.47, p < 0.0001) but were only fairly (Kappa 0.35, p < 0.001) concordant for the type of abnormalities (normal, fixed, ischemia or mixed).
CONCLUSIONS
Dobutamine-atropine stress echocardiography and DMIBI were comparable tests for the detection of CAD. Both were very sensitive for the detection of CAD and moderately sensitive for the extent of disease. The only advantage of DASE was greater specificity, especially for multivessel disease. Dobutamine-atropine stress echocardiography may be advantageous in patients with lower probabilities of CAD.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | DASE | = dobutamine-atropine stress echocardiography | | DMIBI | = dipyridamole Technetium-99m sestamibi single photon emission computed tomographic scintigraphy | | LAD | = left anterior descending coronary artery | | LCX | = left circumflex coronary artery | | MI | = myocardial infarction | | RCA | = right coronary artery | | SPECT | = single photon emission computed tomography | | Tc-99m | = Technetium 99-m |
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