title: Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography.
abstract: BACKGROUND
  We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI) for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE).Wall motion (WM) assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD), particularly in patients with isolated intermediate (50%-70%) coronary stenosis.
  
  
  METHODS
  We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography.
  
  
  CONCLUSIONS
  When CAD was defined as the presence of a >or=50% stenosis, the addition of MPI increased sensitivity (+30%) and decreased specificity (-14%), with a final increase in total diagnostic accuracy (+16%, p < 0.001). The addition of MPI data substantially increased the sensitivity to detect patients with isolated intermediate stenosis from 37% to 98% (p < 0.001); the incremental sensitivity was much lower in patients with severe stenosis, from 85% to 96% (p < 0.05), at the expense of a higher decrease in specificity and a final decrease in total diagnostic accuracy (-18%, p < 0.001).
  
  
  CONCLUSIONS
  The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (>or=50% or > 70% stenosis), but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis).The total diagnostic accuracy increased only when defining CAD as >or=50% stenosis, since in patients with severe stenosis (> 70%) the decrease in specificity is not counterbalanced by the minor sensitivity increase.
authors.affiliation: Cardiology Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gaibazzi
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.forename: Angelo
authors.initials: A
authors.lastname: Squeri
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ugo
authors.forename: Claudio
authors.initials: C
authors.lastname: Reverberi
mesh_terms: D000368:Aged; D001285:Atropine; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis; D023921:Coronary Stenosis / Q000175:diagnosis*; D004176:Dipyridamole; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging; D015588:Observer Variation; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D004176:Dipyridamole; D001285:Atropine
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