Dobutamine stress echocardiography compared with exercise thallium-201 single-photon emission computed tomography in detecting coronary artery disease - effect of exercise level on accuracy
Journal
Cardiology (Switzerland)
Journal Volume
88
Journal Issue
4
Pages
379-385
Date Issued
1997
Author(s)
Huang, Por-Jau
Tseng, Wei-Kung
Chieng, Poon-Ung
Lee, Yuan-Teh
Abstract
Dobutamine stress echocardiography (DSE) and exercise thallium-201 single-photon emission computed tomography (SPECT) were compared for the accuracy in detecting coronary artery disease (CAD) in 51 consecutive patients. Twenty-six (group 1) of the 51 patients achieved adequate exercise end points, and 25 (group 2) did not. There were 38 patients with angiographically documented CAD. The overall sensitivity of DSE and thallium-201 SPECT in detecting CAD was 92 and 76% (p = NS), and the specificity was 77 and 77% (p = NS), respectively. The sensitivity of DSE is the same as that of SPECT in group 1 (90 vs. 90%; p = NS) and higher than that of SPECT in group 2 (94 vs. 61%; p<0.05). In patients with CAD without a history of acute myocardial infarction or pathological Q wave on resting electrocardiogram, the sensitivity of DSE is the same as that of SPECT in group 1 (82 vs. 82%; p = NS) and also higher than that of SPECT in group 2 (90 vs. 40%; p = 0.03). The sensitivity in detecting individual coronary artery lesions with DSE and thallium-201 SPECT was not affected by the exercise level. The agreement between DSE and thallium SPECT in detecting patients with CAD was 88% in group 1 (kappa = 0.69; p<0.001) and 76% in group 2 (kappa = 0.45; p = 0.01). The agreement in detecting vascular territories with ischemia was 68% in group 1 (kappa = 0.30; p<0.01) and 75% in group 2 (kappa = 0.33; p<0.001). The agreement in detecting vascular territories with a scar was 87% in group 1 (kappa -0.55; p<0.001) and 85% in group 2 (kappa = 0.44; p<0.001). In conclusion, the sensitivity and specificity of DSE in detecting CAD are similar to that of thallium-201 SPECT with an exercise level =85% of the maximal predicted heart rate. However, in patients who cannot exercise adequately, DSE is more accurate than thallium SPECT. The agreement between DSE and thallium SPECT in detecting patients with CAD and identifying ischemia of individual vascular territories is also affected by the exercise level. ? 1997 S. Karger AG, Basel.
SDGs
Other Subjects
dobutamine; thallium 201; adult; aged; angiocardiography; article; clinical trial; controlled clinical trial; controlled study; coronary artery disease; diagnostic accuracy; diagnostic value; echocardiography; electrocardiogram; exercise; exercise test; female; heart muscle ischemia; heart rate; human; intermethod comparison; major clinical study; male; priority journal; Q wave; scar; single photon emission computer tomography
Type
journal article