Comparison of dobutamine stress echocardiography and technetium-99m sestamibi single-photon emission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy

Abstract

Stress echocardiography has been considered an accurate method for the diagnosis of coronary artery disease in hypertensive patients and in patients with left ventricular hypertrophy. In contrast, the specificity of myocardial perfusion scintigraphy in these patients has been questioned. The aim of this study was to compare the accuracy of these two imaging modalities in conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Dobutamine (up to 40 microg kg-1min-1) stress echocardiography in conjunction with sestamibi (MIBI) single-photon emission tomography (SPET) was performed in 84 patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography and reversible perfusion defects at SPET. Significant coronary artery disease (>/=50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%-82%), 83% (CI 75%-91%) and 75% (CI 66%-84%), those for MIBI were 67% (CI 57%-77%), 83% (CI 75%-91%) and 70% (CI 60%-80%) respectively (P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity, specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%-69%), 90% (CI 86%-94%) and 77% (CI 72%-82%). Those for MIBI were 58% (CI 51%-64%), 91% (CI 87%-94%) and 75% (CI 69%-80) respectively (P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not influence the overall or regional specificity of echocardiography or MIBI SPET. It is concluded that in hypertensive patients, dobutamine stress echocardiography and MIBI SPET have a comparable accuracy for the overall and regional diagnosis of coronary artery disease. Hypertensive patients with or without left ventricular hypertrophy should not be considered unsuitable candidates for stress myocardial perfusion scintigraphy.

Influence of Left Ventricular Hypertrophy and Geometry on Diagnostic Accuracy of Wall Motion and Perfusion Magnetic Resonance During Dobutamine Stress

“…Concordant with previous reports, we demonstrated that in patients with normal LV mass and normal geometry, DSMR-wall motion has both high sensitivity and high specificity for the detection of hemodynamically relevant CAD. 1,5,6 We could show that an absolute increase in LV mass or septal wall thickness did not adversely affect accuracy of DSMR-wall motion, which is in line with prior studies using echocardiography 18 and cardiovascular MRI (CMR). 9 Although CMR is regarded for its superior image quality that allows for a consistently high definition of the endocardial border in all LV segments, our study demonstrates that LV geometry may limit the diagnostic capability of wallmotion analysis for the detection of stress-inducible ischemic reactions.…”

Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

“…Summarised data from two studies ( Table 2, 286 patients) have demonstrated a somewhat higher sensitivity for perfusion imaging compared to stress echocardiography (87 vs 74%, P<0.005), and confirmed the lower specificity for perfusion imaging (44 vs 85%, P<0.001). 36,37 The diagnosis of coronary artery disease in women may be more challenging due to the lower prevalence of coronary artery disease. In addition, single-vessel disease is a common finding in women.…”

The accuracy of non-invasive methods for the detection of obstructive coronary artery disease in the presence of left ventricular hypertrophy

“…Of those who had an exercise stress and an interpretable ECG, the sensitivity and specificity of the exercise ECG was only 51% and 43% respectively. 17 Elhendy and colleagues, 18 in a population of 84 hypertensive patients, 70% with and 30% without LVH, compared sesta-MIBI SPECT and stress echocardiography for the detection of CAD. Overall 79% of patients had significant CAD.…”

“…The sensitivities and specificities for MPI and DSE were 98% and 88% and 36% and 84% respectively. 23 Elhendy and co-workers 18 found that the overall sensitivity, specificity and for the detection of significant CAD using DSE to be 73% and 83%. There was no significant difference in sensitivity and specificity in the presence of LVH.…”

“…There was also no significant difference in accuracy between DSE and MPI. 18 In the literature there has been no assessment of coronary flow reserve and DSE in hypertensive patients, with or without LVH.…”