INCREMENTAL DIAGNOSTIC-VALUE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY AND DOBUTAMINE SCINTIGRAPHY (TECHNETIUM 99M-LABELED SESTAMIBI SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY) FOR ASSESSMENT OF PRESENCE AND EXTENT OF CORONARY-ARTERY DISEASE

Background. The incremental diagnostic value of dobutamine stress echo cardiography (DSE) and Tc-99m-labeled sestamibi single-photon emission computed tomography for the evaluation of the presence and extent of coronary artery disease (CAD) was assessed with ordered logistic regre ssion and receiver-operating characteristic curves. Methods and Result s. Forty-five consecutive patients (33 men and 12 women; 53 +/- 6.8 ye ars) underwent exercise electrocardiography and simultaneous DSE and s estamibi single-photon emission computed tomographic imaging. Coronary angiography was performed in all patients (significant coronary steno sis >50%). On the basis of the results of exercise electrocardiography , the pretest probability for CAD (Diamond's algorithm) was low (45.6% +/- 12.7%). According to ordered logistic regression analysis, some m odels were estimated that performed a diagnostic accuracy level for CA D. In particular, we evaluated a clinical model (model 1) determined b y the following parameters: sex, age, presence of chest pain, and posi tivity of electrocardiogram during dobutamine stress test. This model was 64.3% +/- 10.7% accurate for the prediction of CAD. The addition t o model 1 of DSE parameters (wall motion stress and rest score index a nd relative difference) (model 2) yielded a diagnostic accuracy of 81. 4% +/- 4.3% (p < 0.045), whereas the addition to model 1 of single-pho ton emission computed tomographic parameters (the difference between p erfusional stress and rest score index) (model 3) improved diagnostic accuracy to 92.3% +/- 5.5% (p < 0.003), a level that appeared signific antly higher than that of model 2 (p < 0.016). Conclusion. Both noninv asive methods for the detection of CAD showed a good diagnostic accura cy, especially when test-derived parameters were combined with clinica l data. Nevertheless, the single-photon emission computed tomographic model showed a higher sensitivity compared with the DSE model.