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High dose dipyridamole-echocardiography test in women: correlation with exercise-electrocardiography test and
M Masini1, E Picano, F Lattanzi
1Istituto del Consiglio Nazionale delle Ricerche, University of Pisa, Italy.
Insights
The high-dose dipyridamole-echocardiography test is more accurate than exercise-electrocardiography for diagnosing coronary artery disease in women. This study found dipyridamole-echocardiography superior in specificity and positive predictive value.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Exercise-electrocardiography (ECG) has limited value in diagnosing coronary artery disease (CAD) in women.
- High-dose dipyridamole-echocardiography (DPE) is a proposed alternative for CAD diagnosis.
Purpose of the Study:
- To compare the diagnostic usefulness of exercise-ECG and DPE for CAD in women with chest pain syndrome.
Main Methods:
- 83 women with chest pain syndrome underwent both exercise-ECG and DPE on separate days.
- Coronary angiography was used as the gold standard for CAD diagnosis.
- Test positivity criteria were defined for both methods.
Main Results:
- DPE showed higher specificity (93% vs 52%), accuracy (87% vs 62%), and positive predictive value (91% vs 57%) compared to exercise-ECG (p < 0.001).
- Sensitivity and negative predictive value were similar between the two tests.
- No significant complications occurred during either procedure.
Conclusions:
- High-dose dipyridamole-echocardiography is a more specific and accurate diagnostic tool for coronary artery disease in women compared to exercise-electrocardiography.
- DPE offers a valuable alternative for evaluating women presenting with chest pain syndrome.
Abstract:
The value of the exercise-electrocardiography test in detecting coronary artery disease in women is limited. Recently, the high dose dipyridamole-echocardiography test (two-dimensional echocardiographic monitoring during intravenous dipyridamole infusion, up to 0.84 mg/kg body weight over 10 min) was proposed as an alternative to exercise testing for the diagnosis of coronary artery disease. To establish the diagnostic usefulness of the exercise-electrocardiography and dipyridamole-echocardiography tests in this disease, the two tests were performed--on different days and in random order--in 83 consecutive women evaluated for a chest pain syndrome. All 83 women had taken no medications for greater than 48 h, and 15 had had a previous myocardial infarction. Positivity of the dipyridamole-echocardiography test was based on detection of a transient asynergy of contraction that was absent or of lesser degree at rest; the exercise-electrocardiography test (by upright cycloergometer) was considered positive when the ST segment was shifted greater than 0.1 mV 0.08 s after the J point. Coronary angiography showed significant coronary artery disease (greater than 70% luminal reduction of at least one major coronary vessel) in 39 women. No significant complications occurred in any patient during either test. Sensitivity and predictive value of a negative test were similar for the dipyridamole-echocardiography and the exercise-electrocardiography test (79 versus 72% and 84 versus 68%, respectively, whereas the dipyridamole-echocardiography test had greater specificity (93 versus 52%, p less than 0.001), accuracy (87 versus 62%, p less than 0.001) and a higher predictive value of a positive test (91 versus 57%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)