title: Incremental diagnostic value of dipyridamole echocardiography and exercise thallium 201 scintigraphy in the assessment of presence and extent of coronary artery disease.
abstract: BACKGROUND
  The incremental diagnostic information of two noninvasive tests for the detection of coronary artery disease (CAD), dipyridamole echocardiography, and exercise 201Tl myocardial scintigraphy was assessed in a series of 102 patients with ordered logistic regression and receiver-operating characteristic curves.
  
  
  RESULTS
  Patients were selected from those referred to our cardiovascular centers with the clinical suspicion of CAD. After clinical evaluation, all patients underwent both noninvasive tests during hospitalization 2 weeks before coronary arteriography. The coronary arteriogram was used as a gold standard: CAD was defined as the presence of one or more vessels with 50% or greater narrowing of the luminal diameter. Clinical data were 73.0% +/- 5.7% accurate in the prediction of CAD. The addition of dipyridamole echocardiographic data to the clinical model yielded a diagnostic accuracy of 88.3% +/- 4.3% (p < 0.00001), whereas the addition of thallium scintigraphic parameters to the clinical model improved diagnostic accuracy to 93.8% +/- 2.6% (p < 0.00001). A significant increase in accuracy to 97.2% +/- 1.4% was achieved when thallium scintigraphic data were added to the clinical and dipyridamole-echocardiographic model (p < 0.00001).
  
  
  CONCLUSIONS
  Both noninvasive methods for detection of CAD, DET, and ETS showed a good diagnostic accuracy especially when tests-derived parameters were combined with clinical data by means of relative logistic models; nevertheless the ETS model showed a higher sensitivity in comparison with the DET model, essentially in presence of a lower extent of CAD.
authors.affiliation: Second Institute of Clinical Medicine, University of Pisa, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Di Bello
authors.forename: E
authors.initials: E
authors.lastname: Gori
authors.forename: C R
authors.initials: CR
authors.lastname: Bellina
authors.forename: O
authors.initials: O
authors.lastname: Parodi
authors.forename: N
authors.initials: N
authors.lastname: Molea
authors.forename: G
authors.initials: G
authors.lastname: Santoro
authors.forename: G
authors.initials: G
authors.lastname: Mariani
authors.forename: U
authors.initials: U
authors.lastname: Conti
authors.forename: E
authors.initials: E
authors.lastname: Magagnini
authors.forename: P
authors.initials: P
authors.lastname: Marzullo
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004176:Dipyridamole; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes
chemical_list: D013794:Thallium Radioisotopes; D004176:Dipyridamole