title: Comparison of dobutamine stress echocardiography, dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging in patients with end-stage renal disease.
abstract: OBJECTIVE
  We sought to assess and compare the diagnostic accuracy and prognostic value of dobutamine stress echocardiography (DSE), dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging (MPI) in patients with end-stage renal disease (ESRD).
  
  
  BACKGROUND
  The optimal stress imaging modality for patients with ESRD has not yet been determined.
  
  
  METHODS
  Forty-nine patients with ESRD underwent DSE, dobutamine SPECT MPI, and adenosine SPECT MPI. The primary endpoint of the trial was concordance between stress tests with respect to the presence or absence of ischemia.
  
  
  RESULTS
  Agreement on the presence or absence of ischemia between adenosine SPECT MPI and DSE was 69% (kappa = .25, P = NS). Agreement on the presence or absence of ischemia between adenosine and dobutamine SPECT MPI was 77% (kappa = .37, P = <.009). Summed stress scores for adenosine and dobutamine SPECT MPI studies were highly correlated (r = .9, P = <.0001). DSE and SPECT MPI results provided incremental prognostic information when added to clinical variables.
  
  
  CONCLUSIONS
  There is moderate concordance between DSE and adenosine SPECT MPI in ESRD patients referred for stress testing. Interobserver agreement was higher for SPECT MPI compared to DSE. Based on these observations, the optimal approach for diagnosing severe coronary artery disease and assessing risk in patients with ESRD has yet to be determined, but appears to warrant further investigation.
authors.affiliation: Hennepin County Medical Center and University of Minnesota, O5 HCMC, 701 Park Avenue South, Minneapolis, MN 55415, USA. bartx006@umn.edu
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Bart
authors.forename: Ye-Ying
authors.initials: YY
authors.lastname: Cen
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hendel
authors.forename: Ramond
authors.initials: R
authors.lastname: Lee
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.forename: Emil D
authors.initials: ED
authors.lastname: Missov
authors.forename: Fouad A
authors.initials: FA
authors.lastname: Bachour
authors.forename: Charles A
authors.initials: CA
authors.lastname: Herzog
mesh_terms: D000241:Adenosine / Q000378:metabolism*; D000368:Aged; D004280:Dobutamine / Q000378:metabolism / Q000494:pharmacology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D010477:Perfusion; D011379:Prognosis; D015203:Reproducibility of Results; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D004280:Dobutamine; D000241:Adenosine