title: How accurate is dobutamine stress electrocardiography for detection of coronary artery disease? Comparison with two-dimensional echocardiography and technetium-99m methoxyl isobutyl isonitrile (mibi) perfusion scintigraphy.
abstract: OBJECTIVE
  This study was designed to establish the appropriate diagnostic criteria for positive dobutamine electrocardiographic (ECG) stress test results and to compare their accuracy with those of dobutamine two-dimensional echocardiography and perfusion scintigraphy.
  
  
  BACKGROUND
  Conventional criteria for positive findings on ECG exercise testing may not be appropriate for use with dobutamine ECG stress testing.
  
  
  METHODS
  One hundred twenty-nine consecutive patients with an interpretable ECG and without previous myocardial infarction were prospectively studied at the time of coronary arteriography. All completed a standard dobutamine protocol (5 to 40 micrograms/kg body weight per min in 3-min dose increments) without side effects. Significant coronary artery disease, defined as > 50% lumen diameter stenosis of a major epicardial coronary artery on coronary angiography, was present in 83 patients. Empiric receiver operating curves were generated for various ECG criteria derived from computer-averaged signals.
  
  
  RESULTS
  The best ECG criterion, with a sensitivity of 42% and a specificity of 83%, was an ST segment shift, relative to baseline, of 0.5 mm 80 ms after the J point. The sensitivity of this criterion was greater than that of the conventional criterion of 1-mm ST segment depression 60 (23%) or 80 (18%) ms after the J point, was comparable to that of chest pain occurring during the test (44%, p = NS) but remained inferior to the sensitivities of technetium-99m methoxyl isobutyl isonitrile (mibi) perfusion (76%) or stress echocardiography (76%, p < 0.001, for both). The specificity of this criterion was not significantly different from that of technetium-99m mibi perfusion tomography (65%) or stress echocardiography (89%) but was superior to that of chest pain (59%, p < 0.025).
  
  
  CONCLUSIONS
  We conclude that this new criterion for dobutamine electrocardiography is specific but that an imaging technique is still required to accurately predict coronary artery disease.
authors.affiliation: Division of Cardiology, University of Louvain Medical School, Brussels, Belgium.
authors.forename: G H
authors.initials: GH
authors.lastname: Mairesse
authors.forename: T H
authors.initials: TH
authors.lastname: Marwick
authors.forename: J L
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: T
authors.initials: T
authors.lastname: Baudhuin
authors.forename: W
authors.initials: W
authors.lastname: Wijns
authors.forename: J A
authors.initials: JA
authors.lastname: Melin
authors.forename: J M
authors.initials: JM
authors.lastname: Detry
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004280:Dobutamine; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D017256:Technetium Tc 99m Sestamibi
chemical_list: D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi