Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: Limitations and concordance

OBJECTIVES We sought to compare dobutamine-atropine stress echocardiography (DASE) and dipyridamole Technetium 99-m (Tc-99m) sestamibi single photon e mission computed tomography (SPECT) scintigraphy (DMIBI) for detecting coro nary artery disease (CAD). BACKGROUND Both DASE and DMIBI are effective for evaluating patients for CA D, but their concordance and limitations have not been directly compared. METHODS To investigate these aims, patients underwent multistage DASE, DMIB I and coronary angiography within three months. Dobutamine-atropine stress echocardiography and stress-rest DMIBI were performed according to standard techniques and analyzed for their accuracy in predicting the extent of CAD . Segments were assigned to vascular territories according to standard mode ls. Angiography was performed using the Judkin's technique. RESULTS The 183 patients (mean age: 60 +/- 11 years, including 50 women) co nsisted of 64 patients with no coronary disease and 61 with single-, 40 wit h two- and 18 with three-vessel coronary disease. Dobutamine-atropine stres s echocardiography and DMIBI were similarly sensitive (87%, 104/119 and 80% , 95/119, respectively) for the detection of CAD, but DASE was more specifi c (91%, 58/64 vs. 73%, 47/64, p < 0.01). Sensitivity was similar for the de tection of CAD in patients with single-vessel disease (84%, 51/61 vs. 74%, 45/61, respectively) and multivessel disease (91%, 53/58 vs. 86%, 50/58, re spectively). Multiple wall motion ai,normalities and perfusion defects were similarly sensitive for multivessel disease (72%, 42/58 vs. 66%, 38/53, re spectively), but, again, DASE was more specific than DMIBI (95%, 119/125 vs . 76%, 95/125, respectively, p < 0.01). Dobutamine-atropine stress echocard iography and DMIBI were moderately concordant for the detection and extent of CAD (Kappa 0.47, p < 0.0001) bur were only fairly (Kappa 0.35, p < 0.001 ) concordant for the type of abnormalities (normal, fixed, ischemia or mixe d). CONCLUSIONS Dobutamine-atropine stress echocardiography and DMIBI were comp arable tests for the detection of CAD. Both were very sensitive for the det ection of CAD and moderately sensitive for the extent of disease. The only advantage of DASE was greater specificity, especially for multivessel disea se. Dobutamine-atropine stress echocardiography may be advantageous in pati ents with lower probabilities of CAD. CT Am Coil Cardiol 2000;36: 1265-73) (C) 2000 by the American College of Cardiology.