Comparison of Exercise Stress Testing with Dobutamine Stress Echocardiography and Exercise Technetium-99m Isonitrile Single Photon Emission Computerized Tomography for Diagnosis of Coronary Artery Disease.

Abstract

SUMMARYTo compare the value of exercise electrocardiography with dobutamine stress echocardiography and exercise technetium-99m isonitrile single-photon emission computed tomography for coronary artery disease, 70 patients with either suspected or proven coronary artery disease underwent dobutamine stress echocardiography, exercise technetium-99m isonitrile single-photon emission computed tomography (mibi-SPECT) and treadmill exercise electrocardiography (ECG). Dobutamine echocardiography and exercise mibi-SPECT revealed a higher overall sensitivitiy than exercise testing (90 vs 57%, p<0.001; 96 vs 57%, p<0.001, respectively). Dobutamine stress echocardiography showed a higher specificity than both exercise mibi-SPECT and treadmill exercise electrocardiography (90 vs 71%, p>0.05; 90 and 62% p<0.05, respectively) but the difference between dobutamine stress echocardiography and exercise mibi-SPECT was not statistically significant. Diagnostic accuracy of dobutamine stress echocardiography and exercise mibi-SPECT was higher than that of exercise testing (90 vs 59%, p<0.001; 89 vs 59%, p<0.001, respectively).Dobutamine stress echocardiography and exercise mibi-SPECT have superiority over exercise testing in the diagnosis of coronary artery disease and dobutamine stress echocardiography is an alternative for exercise mibi-SPECT. (Jpn Heart J 1997; 38: 333-344)

Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies

“…Upon additional review of full‐text articles, 34 studies with 3,352 participants were included in the systematic review (20–53). Studies excluded at the second stage are listed in the reference list (54–124). Table 1 shows that the vast majority of the included studies were from Western Europe and North America (13 from the United States).…”

Diagnostic accuracy of myocardial perfusion imaging and stress echocardiography for the diagnosis of left main and triple vessel coronary artery disease: a comparative meta-analysis

“…The forest plot for sensitivity (figure 2) showed heterogeneity (Cochrane Q p<0.1). Six small-sample-size studies were primarily responsible for this heterogeneity 37 39 43 45 47 49. However, there was no significant heterogeneity in the forest plot for negative likelihood ratio (1−Sensitivity/Specificity; figure 3), implying that it is reasonable to combine the included studies to obtain pooled estimates.…”

“…Six studies reported use of both MPI and SE to diagnose CAD in the same cohort. 36 37 39 40 47 49 The study characteristics of the included studies for high-risk CAD analysis are shown in table 1. Data on high-risk CAD patients with reduced left ventricular ejection fraction were not uniformly abstractable for the included studies.…”

“…SE had significantly higher area under SROC curves (0.82 vs 0.73, p=0.02) with superior sensitivity (94% vs 78%, p<0.01), negative likelihood ratio (0.21 vs 0.44, p<0.01) and DOR (9.78 vs 3.93, p=0.02). However, paucity of abstractable data on studies incorporating recent advances (including gated-SPECT, spatial normalisation and novel echocardiography technologies such as myocardial contrast perfusion, transesophageal, harmonic and strain imaging) precluded any meaningful contemporary comparisons. Comparison of the performance of SE and MPI for detection of high-risk CAD using data from studies with reported outcome data for both stress modalities by the same author 36 37 39 40 47 49The sample size was significantly lower for this analysis and added up to roughly one-sixth of patients with high-risk CAD. SE had a significantly higher area under SROC curve (0.80 vs 0.70, p=0.04) and higher sensitivity (93% vs 84%, p=0.04) without any evidence of a difference in specificity (46% vs 39 %, p=0.14) and DOR (7.00 vs 4.47, p=0.32) in comparison to MPI.…”

“…Comparison of the performance of SE and MPI for detection of high-risk CAD using data from studies with reported outcome data for both stress modalities by the same author 36 37 39 40 47 49…”