title: Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: limitations and concordance.
abstract: OBJECTIVE
  We sought to compare dobutamine-atropine stress echocardiography (DASE) and dipyridamole Technetium 99-m (Tc-99m) sestamibi single photon emission computed tomography (SPECT) scintigraphy (DMIBI) for detecting coronary artery disease (CAD).
  
  
  BACKGROUND
  Both DASE and DMIBI are effective for evaluating patients for CAD, but their concordance and limitations have not been directly compared.
  
  
  METHODS
  To investigate these aims, patients underwent multistage DASE, DMIBI and coronary angiography within three months. Dobutamine-atropine stress echocardiography and stress-rest DMIBI were performed according to standard techniques and analyzed for their accuracy in predicting the extent of CAD. Segments were assigned to vascular territories according to standard models. Angiography was performed using the Judkin's technique.
  
  
  RESULTS
  The 183 patients (mean age: 60 +/- 11 years, including 50 women) consisted of 64 patients with no coronary disease and 61 with single-, 40 with two- and 18 with three-vessel coronary disease. Dobutamine-atropine stress echocardiography and DMIBI were similarly sensitive (87%, 104/119 and 80%, 95/119, respectively) for the detection of CAD, but DASE was more specific (91%, 58/64 vs. 73%, 47/64, p < 0.01). Sensitivity was similar for the detection of CAD in patients with single-vessel disease (84%, 51/61 vs. 74%, 45/61, respectively) and multivessel disease (91%, 53/58 vs. 86%, 50/58, respectively). Multiple wall motion abnormalities and perfusion defects were similarly sensitive for multivessel disease (72%, 42/58 vs. 66%, 38/53, respectively), but, again, DASE was more specific than DMIBI (95%, 119/125 vs. 76%, 95/125, respectively, p < 0.01). Dobutamine-atropine stress echocardiography and DMIBI were moderately concordant for the detection and extent of CAD (Kappa 0.47, p < 0.0001) but were only fairly (Kappa 0.35, p < 0.001) concordant for the type of abnormalities (normal, fixed, ischemia or mixed).
  
  
  CONCLUSIONS
  Dobutamine-atropine stress echocardiography and DMIBI were comparable tests for the detection of CAD. Both were very sensitive for the detection of CAD and moderately sensitive for the extent of disease. The only advantage of DASE was greater specificity, especially for multivessel disease. Dobutamine-atropine stress echocardiography may be advantageous in patients with lower probabilities of CAD.
authors.affiliation: Division of Cardiology, Gundersen Lutheran, University of Wisconsin, La Crosse 54601, USA. scsmart@gundluth.org
authors.forename: S C
authors.initials: SC
authors.lastname: Smart
authors.forename: A
authors.initials: A
authors.lastname: Bhatia
authors.forename: R
authors.initials: R
authors.lastname: Hellman
authors.forename: T
authors.initials: T
authors.lastname: Stoiber
authors.forename: A
authors.initials: A
authors.lastname: Krasnow
authors.forename: B D
authors.initials: BD
authors.lastname: Collier
authors.forename: K B
authors.initials: KB
authors.lastname: Sagar
mesh_terms: D001285:Atropine / Q000008:administration & dosage; D002316:Cardiotonic Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010276:Parasympatholytics / Q000008:administration & dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002316:Cardiotonic Agents; D010276:Parasympatholytics; D019275:Radiopharmaceuticals; D004280:Dobutamine; D001285:Atropine; D017256:Technetium Tc 99m Sestamibi