COMPARISON OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY AND TREADMILL EXERCISE ELECTROCARDIOGRAPHY FOR DETECTION OF CORONARY-ARTERY DISEASE

Background Critical analysis of treadmill exercise testing (TMET) for the detection of coronary artery disease has revealed many shortcoming s. Excellent diagnostic accuracy has been reported for dobutamine stre ss echocardiography (DSE). Methods A prospective comparison of DSE and TMET for the detection of coronary artery disease in routine clinical practice was performed using contrast cineangiography (significant st enosis greater than or equal to 50%) as a gold standard. Results A tot al of 116 patients (82 men, 34 women) were studied. Significant stenos is was detected by coronary angiography in 92 patients (79%). Single v essel disease occurred in 28, double-vessel disease in 32, and multive ssel disease in 32 patients. Although sensitivity of DSE was better th an that of TMET (82 versus 40%), specificity was worse (63 versus 79%) . Positive predictive values for both DSE and TMET were good at 89 and 87%, respectively, whereas negative predictive values were poor for b oth (47% for DSE, 26% for TMET). Conclusions Overall, DSE performs bet ter than TMET in terms of sensitivity and positive and negative predic tive value. Its lower specificity than that of TMET may lead to more p atients being referred for diagnostic coronary angiography. The poor n egative predictive value of DSE and TMET means that one should not be falsely reassured by normal results.