The comparable diagnostic accuracies of dobutamine-stress and dipyridamole-stress echocardiographies: a meta-analysis

Background Dobutamine-stress and dipyridamole-stress echocardiographies are widely used for pharmacological stress echocardiography, with wide geograp hical variations. Objective To assess whether evidence derived from the literature indicates or disproves that either stress modality confers diagnostic superiority. Methods We performed a me ia-analysis of peer-reviewed literature of publis hed trials with head-to-head comparison, on the same population, of high-do se (0.84 mg/kg) dipyridamole-stress versus high-dose (up to 40 mu g/kg per min) dobutamine-stress echocardiography, Data from 12 studies performed in 12 institutions in seven countries were analysed. Angiographic information about 818 patients was considered. Results The diagnostic accuracies of the two tests were similar (631 of 818 , 77%, for dipyridamole versus 654 of 818, 80%, for dobutamine, NS). Overal l sensitivities were 403 of 568 (71%) for dipyridamole and 437 of 568 (77%) for dobutamine (P < 0.05). Sensitivities for patients with single-vessel d isease were 177 of 275 (64%) for dipyridamole and 203 of 275 (74%) for dobu tamine (P < 0.05), Sensitivities for patients with multivessel disease were 162 of 203 (80%) for dipyridamole and 163 of 203 (80%) for dobutamine (NS) . Specificities were 232 of 250 (93%) for dipyridamole and 217 of 250 (87%) for dobutamine (P < 0.05), Data from an additional 26 studies with dipyrid amole alone and 47 studies with dobutamine alone were analysed, The diagnos tic accuracies were 80% for dipyridamole (n = 2038 patients; 95% confidence interval 75-82%) and 82% for dobutamine (n = 4264 patients; 95% confidence interval 79-84%). Conclusion High-dose dobutamine-stress and high-dose dipyridamole-stress ec hocardiographies have comparable diagnostic accuracies, with a slightly hig her sensitivity with dobutamine and a slightly higher specificity with dipy ridamole. Coronary Artery Dis 11:151-159 (C) 2000 Lippincott Williams & Wil kins.