title: Enhanced diagnosis of coronary artery disease in women by dobutamine thallium-201 ST-segment/heart rate slope and thallium-201 myocardial SPECT.
abstract: OBJECTIVE
  The diagnosis of coronary artery disease (CAD) in women presents a great challenge because of poor exercise capacity and inadequate heart rate response during stress test. The clinical significance of stress-related ST-segment/heart rate slope (ST/HR slope) value for evaluating CAD in women remains controversial. Therefore, we conducted the present study to assess the diagnostic performance of dobutamine ST/HR slope in women, compared with myocardial perfusion study using thallium-201 single-photon emission computed tomography (Tl-201 SPECT).
  
  
  METHODS
  A total of 51 female patients with suspected CAD underwent simultaneous 12-lead electrocardiographic recording during 3-minute stages of dobutamine infusion as well as Tl-201 SPECT, and coronary angiography was performed within 2 weeks post Tl-201 SPECT. The sensitivity, specificity, positive predictive value and negative predictive value of dobutamine ST/HR slope and Tl-201 SPECT were assessed, and the results of coronary angiography were used as a gold standard.
  
  
  RESULTS
  The sensitivity, specificity and accuracy of dobutamine ST/HR slope in detecting CAD were 43%, 83% and 61%, and those of Tl-201 SPECT were 71%, 87% and 78%, respectively. However, using both positive results of Tl-201 SPECT and ST/HR slope for detecting CAD, the diagnostic specificity increased from 87% to 96%. Using both negative results of Tl-201 SPECT and ST/HR slope to exclude CAD, the negative predictive value increased from 71% to 85%. The accuracy of dobutamine ST/HR slope in detecting CAD was not affected by the use of beta-blockers.
  
  
  CONCLUSIONS
  Dobutamine ST/HR slope is less sensitive and less accurate than Tl-201 SPECT for detecting CAD in women. However, it adds diagnostic benefit to Tl-201 SPECT with only a little extra calculation.
authors.affiliation: Department of Cardiology, Far Eastern Memorial Hospital, Pan-Chiao, Taiwan.
authors.forename: Dong-Feng
authors.initials: DF
authors.lastname: Yeih
authors.forename: Por-Jau
authors.initials: PJ
authors.lastname: Huang
authors.forename: Yi-Lwun
authors.initials: YL
authors.lastname: Ho
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis*; D004280:Dobutamine; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D004280:Dobutamine