Optimal criteria for the diagnosis of coronary artery disease by dobutamine stress echocardiography

The diagnosis of coronary artery disease [CAD) on the basis of inducible is chemia in greater than or equal to 2, rather than greater than or equal to 1, segments was suggested to improve specificity of dobutamine stress echoc ardiography (DSE). However, the impact of using these criteria on the sensi tivity and accuracy of DSE was not studied. We studied the accuracy of DSE (up to 40 mu g/kg/min) for the diagnosis of CAD in 290 patients with suspec ted myocardial ischemia using the criteria of greater than or equal to 1 an d greater than or equal to 2 ischemic segments. Ischemia wets defined as ne w or worsening wall motion abnormalities using a 16-segment model. Among th e 85 patients without previous myocardial infarction, significant CAD was d etected in 51 (60%). Sensitivity, specificity, and accuracy of DSE using gr eater than or equal to 1 ischemic segment were 73%, 85%, and 78%, respectiv ely. Those using greater than or equal to 2 segments were 67%, 94%, and 78% , respectively (p = NS). Regional specificity improved by using greater tha n or equal to 2 segments (91% vs 96%, p <0.05) at the expense of an equival ent reduction in regional sensitivity (60% vs 44%, p <0.05), whereas the re gional accuracy was similar (80% vs 79% for greater than or equal to 1 and greater than or equal to 2 segments, respectively). In the 205 patients wit h previous myocardial infarction, the criterion of ischemia in greater than or equal to 1 segment had a higher sensitivity and accuracy for overall di agnosis of CAD (75% vs 64%, p <0.05; 77% vs 68%, p <0.05), infarct-related CAD (64% vs 47%,p <0.005; 70% vs 57%, p <0.01), and remote CAD (74% vs 57%, p <0.005; 78% vs 69%, p <0.05) than the criterion of greater than or equal to 2 segments, respectively. It is concluded that in patients without prev ious myocardial infarction, the use of greater than or equal to 2 ischemic segments by DSE for the diagnosis of CAD does not improve the accuracy of D SE compared with the criterion of greater than or equal to 1 ischemic segme nt. Conversely, in patients with previous infarction the use of greater tha n or equal to 2 segments reduces the overall and regional sensitivity and a ccuracy without a significant improvement in specificity. (C) 1998 by Excer pta Medica, Inc.