COMPARATIVE-EVALUATION OF BICYCLE AND DOBUTAMINE STRESS ECHOCARDIOGRAPHY WITH PERFUSION SCINTIGRAPHY AND BICYCLE ELECTROCARDIOGRAM FOR IDENTIFICATION OF CORONARY-ARTERY DISEASE

In 66 patients with suspected coronary artery disease (CAD), exercise electrocardiography (ECG), exercise echocardiography, dobutamine stres s echocardiography (dosage, 5 to 40 mug/kg/min), single-photon emissio n computed tomography (SPECT) using methoxy-isobutyl-isonitrile (MIBI) and coronary angiography were performed prospectively to compare meth ods for detecting CAD. CAD was defined as 70% luminal area stenosis in at least 1 coronary artery at coronary angiography. Significant CAD w as present in 50 patients. Compared with exercise ECG, exercise echoca rdiography, dobutamine stress echocardiography and MIBI-SPECT had a si gnificantly higher sensitivity (52% vs 80, 79 and 89%; p < 0.01, p < 0 .01 and p < 0.001, respectively). There were no significant difference s in sensitivity between exercise echocardiography, dobutamine stress echocardiography and MIBI-SPECT. Specificity of MIBI-SPECT was lowest (71%), whereas exercise ECG, exercise and dobutamine echocardiography had higher specificities (93, 87 and 81%, respectively). Significance, however, was not achieved. Differences in overall accuracy between ex ercise echocardiography (82%), dobutamine stress echocardiography (80% ) and MIBI-SPECT (85%) were not significant. Comparison with accuracy of exercise ECG (62%) was significant (p < 0.05, p < 0.05 and p < 0.01 , respectively). In 1-vessel disease, exercise ECG had a lower sensiti vity (45%) than exercise and dobutamine echocardiography and MIBI-SPEC T (79, 78 and 84%; p < 0.02, p < 0.02 and p < 0.01, respectively). Reg arding the 24 patients with false-negative exercise ECG results, 67% h ad positive exercise echocardiography findings 71% positive dobutamine echocardiography results and 84% positive technetium-99m. MIBI-SPECT results. Thus, exercise echocardiography and dobutamine stress echocar diography are markedly superior in sensitivity to exercise ECG, especi ally in 1-vessel disease, and represent a useful alternative to myocar dial SPECT.