title: Incremental diagnostic value of dobutamine stress echocardiography and dobutamine scintigraphy (technetium 99m-labeled sestamibi single-photon emission computed tomography) for assessment of presence and extent of coronary artery disease.
abstract: BACKGROUND
  The incremental diagnostic value of dobutamine stress echocardiography (DSE) and 99mTc-labeled sestamibi single-photon emission computed tomography for the evaluation of the presence and extent of coronary artery disease (CAD) was assessed with ordered logistic regression and receiver-operating characteristic curves.
  
  
  RESULTS
  Forty-five consecutive patients (33 men and 12 women; 53 +/- 6.8 years) underwent exercise electrocardiography and simultaneous DSE and sestamibi single-photon emission computed tomographic imaging. Coronary angiography was performed in all patients (significant coronary stenosis > 50%). On the basis of the results of exercise electrocardiography, the pretest probability for CAD (Diamond's algorithm) was low (45.6% +/- 12.7%). According to ordered logistic regression analysis, some models were estimated that performed a diagnostic accuracy level for CAD. In particular, we evaluated a clinical model (model 1) determined by the following parameters: sex, age, presence of chest pain, and positivity of electrocardiogram during dobutamine stress test. This model was 64.3% +/- 10.7% accurate for the prediction of CAD. The addition to model 1 of DSE parameters (wall motion stress and rest score index and relative difference) (model 2) yielded a diagnostic accuracy of 81.4% +/- 4.3% (p < 0.045), whereas the addition to model 1 of single-photon emission computed tomographic parameters (the difference between perfusional stress and rest score index) (model 3) improved diagnostic accuracy to 92.3% +/- 5.5% (p < 0.003), a level that appeared significantly higher than that of model 2 (p < 0.016).
  
  
  CONCLUSIONS
  Both noninvasive methods for the detection of CAD showed a good diagnostic accuracy, especially when test-derived parameters were combined with clinical data. Nevertheless, the single-photon emission computed tomographic model showed a higher sensitivity compared with the DSE model.
authors.affiliation: Second Institute of Clinical Medicine, University of Pisa, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Di Bello
authors.forename: C R
authors.initials: CR
authors.lastname: Bellina
authors.forename: E
authors.initials: E
authors.lastname: Gori
authors.forename: N
authors.initials: N
authors.lastname: Molea
authors.forename: L
authors.initials: L
authors.lastname: Talarico
authors.forename: G
authors.initials: G
authors.lastname: Boni
authors.forename: E
authors.initials: E
authors.lastname: Magagnini
authors.forename: F
authors.initials: F
authors.lastname: Matteucci
authors.forename: D
authors.initials: D
authors.lastname: Giorgi
authors.forename: E
authors.initials: E
authors.lastname: Lazzeri
authors.forename: A
authors.initials: A
authors.lastname: Bertini
authors.forename: M F
authors.initials: MF
authors.lastname: Romano
authors.forename: R
authors.initials: R
authors.lastname: Bianchi
authors.forename: C
authors.initials: C
authors.lastname: Giusti
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology; D002316:Cardiotonic Agents; D017023:Coronary Angiography / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D004280:Dobutamine; D004452:Echocardiography; D004562:Electrocardiography / Q000187:drug effects; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi