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Dobutamine stress echocardiography compared with exercise thallium-201 single-photon emission computed tomography in
1Department of Internal Medicine (Cardiology), National Taiwan University Hospital, Taipei, ROC.
Insights
Dobutamine stress echocardiography (DSE) offers higher accuracy than exercise thallium-201 SPECT for detecting coronary artery disease (CAD) in patients unable to exercise adequately. Both methods show similar overall accuracy when sufficient exercise is achieved.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Coronary artery disease (CAD) diagnosis relies on accurate non-invasive imaging.
- Dobutamine stress echocardiography (DSE) and exercise thallium-201 single-photon emission computed tomography (SPECT) are established methods for CAD detection.
- Patient's ability to exercise significantly impacts the diagnostic performance of stress imaging techniques.
Purpose of the Study:
- To compare the diagnostic accuracy of DSE and exercise thallium-201 SPECT in detecting CAD.
- To evaluate the influence of exercise capacity on the performance of both imaging modalities.
- To assess the agreement between DSE and thallium-201 SPECT in identifying CAD, ischemia, and scar.
Main Methods:
- A comparative study involving 51 consecutive patients with suspected CAD.
- Patients were divided into two groups based on achieving adequate exercise endpoints.
- Coronary angiography was used as the gold standard for CAD diagnosis.
Main Results:
- Overall sensitivity for DSE was 92% and for thallium-201 SPECT was 76% (p=NS).
- In patients with inadequate exercise, DSE sensitivity (94%) was significantly higher than thallium-201 SPECT (61%, p<0.05).
- Agreement between DSE and thallium-201 SPECT varied based on exercise level, particularly in identifying ischemia.
Conclusions:
- Dobutamine stress echocardiography (DSE) demonstrates superior accuracy compared to exercise thallium-201 SPECT in patients with limited exercise capacity.
- Both DSE and thallium-201 SPECT show comparable diagnostic performance when adequate exercise is achieved.
- Exercise capacity is a critical factor influencing the agreement and diagnostic yield of stress imaging for CAD.
Abstract:
Dobutamine stress echocardiography (DSE) and exercise thallium-201 single-photon emission computed tomography (SPECT) were compared for the accuracy in detecting coronary artery disease (CAD) in 51 consecutive patients. Twenty-six (group 1) of the 51 patients achieved adequate exercise end points, and 25 (group 2) did not. There were 38 patients with angiographically documented CAD. The overall sensitivity of DSE and thallium-201 SPECT in detecting CAD was 92 and 76% (p = NS), and the specificity was 77 and 77% (p = NS), respectively. The sensitivity of DSE is the same as that of SPECT in group 1 (90 vs. 90%; p = NS) and higher than that of SPECT in group 2 (94 vs. 61%; p < 0.05). In patients with CAD without a history of acute myocardial infarction or pathological Q wave on resting electrocardiogram, the sensitivity of DSE is the same as that of SPECT in group 1 (82 vs. 82%; p = NS) and also higher than that of SPECT in group 2 (90 vs. 40%; p = 0.03). The sensitivity in detecting individual coronary artery lesions with DSE and thallium-201 SPECT was not affected by the exercise level. The agreement between DSE and thallium SPECT in detecting patients with CAD was 88% in group 1 (kappa = 0.69; p < 0.001) and 76% in group 2 (kappa = 0.45; p = 0.01). The agreement in detecting vascular territories with ischemia was 68% in group 1 (kappa = 0.30; p < 0.01) and 75% in group 2 (kappa = 0.33; p < 0.001). The agreement in detecting vascular territories with a scar was 87% in group 1 (kappa = 0.55; p < 0.001) and 85% in group 2 (kappa = 0.44; p < 0.001). In conclusion, the sensitivity and specificity of DSE in detecting CAD are similar to that of thallium-201 SPECT with an exercise level > or =85% of the maximal predicted heart rate. However, in patients who cannot exercise adequately, DSE is more accurate than thallium SPECT. The agreement between DSE and thallium SPECT in detecting patients with CAD and identifying ischemia of individual vascular territories is also affected by the exercise level.