Comparison of dobutamine stress echocardiography, dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging in patients with end-stage renal disease.
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.
Bart
Bradley A
BA
Hennepin County Medical Center and University of Minnesota, O5 HCMC, 701 Park Avenue South, Minneapolis, MN 55415, USA. bartx006@umn.edu
Cen
Ye-Ying
YY
Hendel
Robert C
RC
Lee
Ramond
R
Marwick
Thomas H
TH
Missov
Emil D
ED
Bachour
Fouad A
FA
Herzog
Charles A
CA
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*
D004280:Dobutamine; D000241:Adenosine