Head-to-head comparison of dipyridamole echocardiography and stress perfusion scintigraphy for the detection of coronary artery disease: A meta-analysis. Comparison between stress echo and scintigraphy

Muhammad B. Imran, A. Pálinkás, Eugenio Picano

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26 Citations (Scopus)

Abstract

Objectives: This meta-analysis was performed to assess and compare the diagnostic accuracy of dipyridamole echocardiography test (DET) vs. stress perfusion scintigraphy (SPS) for the diagnosis of coronary disease (CAD). Methods: We performed a meta-analysis of peer reviewed articles, published in English language reporting head-to-head comparison of DET vs. SPS for the diagnosis of CAD. Data of 10 studies comprising 651 patients from 10 different institutions were analyzed. DET dose was 0.56 mg/kg (low dose) in two studies, 0.75 mg/kg in 10 min or 0.84 mg/kg in 10 min (high-dose) in six studies, and 0.84 mg/kg in 6 min (accelerated high dose) in one study and 0.84 mg/kg in 10 min + 1 mg atropine co-administration (augmented dose) in one study. SPS was performed with dipyridamole in six studies, with exercise in three studies and with dobutamine in one study. Results: The overall diagnostic accuracy of the two tests was almost similar, 77% (95% CI = 74-81) for DET vs. 81% (95% CI = 78-84) for SPS (p = ns). SPS gave higher sensitivity, 88% (95% CI = 85-89) than DET, 70% (95% CI = 66-75) in cumulative data (p <0.0001) while DET gave higher specificity, 90% (95% CI = 86-94) vs. 67% (95% CI = 60-73) (p <0.0001). With state of the art protocols, i.e. accelerated dose and atropine augmented high dose, sensitivity of DET improved and overall accuracy was better than SPS (p <0.05). Conclusion: DET and SPS have a similar diagnostic accuracy. DET has a markedly higher specificity regardless of the dose employed. SPS shows a superior sensitivity, however this sensitivity gap diminishes when more aggressive dipyridamole dosage is used for the stress echocardiography.

Original languageEnglish
Pages (from-to)23-28
Number of pages6
JournalInternational Journal of Cardiovascular Imaging
Volume19
Issue number1
DOIs
Publication statusPublished - Feb 2003

Fingerprint

Stress Echocardiography
Perfusion Imaging
Dipyridamole
Radionuclide Imaging
Meta-Analysis
Coronary Artery Disease
Echocardiography
Atropine
Coronary Disease
Dobutamine
Exercise Test
Language

Keywords

  • Dipyridamole stress echocardiography
  • Head-to-head comparison
  • Meta-analysis
  • Stress myocardial scintigraphy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • Radiological and Ultrasound Technology

Cite this

@article{923cb3ade3d341498166f9dfe569d3e2,
title = "Head-to-head comparison of dipyridamole echocardiography and stress perfusion scintigraphy for the detection of coronary artery disease: A meta-analysis. Comparison between stress echo and scintigraphy",
abstract = "Objectives: This meta-analysis was performed to assess and compare the diagnostic accuracy of dipyridamole echocardiography test (DET) vs. stress perfusion scintigraphy (SPS) for the diagnosis of coronary disease (CAD). Methods: We performed a meta-analysis of peer reviewed articles, published in English language reporting head-to-head comparison of DET vs. SPS for the diagnosis of CAD. Data of 10 studies comprising 651 patients from 10 different institutions were analyzed. DET dose was 0.56 mg/kg (low dose) in two studies, 0.75 mg/kg in 10 min or 0.84 mg/kg in 10 min (high-dose) in six studies, and 0.84 mg/kg in 6 min (accelerated high dose) in one study and 0.84 mg/kg in 10 min + 1 mg atropine co-administration (augmented dose) in one study. SPS was performed with dipyridamole in six studies, with exercise in three studies and with dobutamine in one study. Results: The overall diagnostic accuracy of the two tests was almost similar, 77{\%} (95{\%} CI = 74-81) for DET vs. 81{\%} (95{\%} CI = 78-84) for SPS (p = ns). SPS gave higher sensitivity, 88{\%} (95{\%} CI = 85-89) than DET, 70{\%} (95{\%} CI = 66-75) in cumulative data (p <0.0001) while DET gave higher specificity, 90{\%} (95{\%} CI = 86-94) vs. 67{\%} (95{\%} CI = 60-73) (p <0.0001). With state of the art protocols, i.e. accelerated dose and atropine augmented high dose, sensitivity of DET improved and overall accuracy was better than SPS (p <0.05). Conclusion: DET and SPS have a similar diagnostic accuracy. DET has a markedly higher specificity regardless of the dose employed. SPS shows a superior sensitivity, however this sensitivity gap diminishes when more aggressive dipyridamole dosage is used for the stress echocardiography.",
keywords = "Dipyridamole stress echocardiography, Head-to-head comparison, Meta-analysis, Stress myocardial scintigraphy",
author = "Imran, {Muhammad B.} and A. P{\'a}link{\'a}s and Eugenio Picano",
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T1 - Head-to-head comparison of dipyridamole echocardiography and stress perfusion scintigraphy for the detection of coronary artery disease

T2 - A meta-analysis. Comparison between stress echo and scintigraphy

AU - Imran, Muhammad B.

AU - Pálinkás, A.

AU - Picano, Eugenio

PY - 2003/2

Y1 - 2003/2

N2 - Objectives: This meta-analysis was performed to assess and compare the diagnostic accuracy of dipyridamole echocardiography test (DET) vs. stress perfusion scintigraphy (SPS) for the diagnosis of coronary disease (CAD). Methods: We performed a meta-analysis of peer reviewed articles, published in English language reporting head-to-head comparison of DET vs. SPS for the diagnosis of CAD. Data of 10 studies comprising 651 patients from 10 different institutions were analyzed. DET dose was 0.56 mg/kg (low dose) in two studies, 0.75 mg/kg in 10 min or 0.84 mg/kg in 10 min (high-dose) in six studies, and 0.84 mg/kg in 6 min (accelerated high dose) in one study and 0.84 mg/kg in 10 min + 1 mg atropine co-administration (augmented dose) in one study. SPS was performed with dipyridamole in six studies, with exercise in three studies and with dobutamine in one study. Results: The overall diagnostic accuracy of the two tests was almost similar, 77% (95% CI = 74-81) for DET vs. 81% (95% CI = 78-84) for SPS (p = ns). SPS gave higher sensitivity, 88% (95% CI = 85-89) than DET, 70% (95% CI = 66-75) in cumulative data (p <0.0001) while DET gave higher specificity, 90% (95% CI = 86-94) vs. 67% (95% CI = 60-73) (p <0.0001). With state of the art protocols, i.e. accelerated dose and atropine augmented high dose, sensitivity of DET improved and overall accuracy was better than SPS (p <0.05). Conclusion: DET and SPS have a similar diagnostic accuracy. DET has a markedly higher specificity regardless of the dose employed. SPS shows a superior sensitivity, however this sensitivity gap diminishes when more aggressive dipyridamole dosage is used for the stress echocardiography.

AB - Objectives: This meta-analysis was performed to assess and compare the diagnostic accuracy of dipyridamole echocardiography test (DET) vs. stress perfusion scintigraphy (SPS) for the diagnosis of coronary disease (CAD). Methods: We performed a meta-analysis of peer reviewed articles, published in English language reporting head-to-head comparison of DET vs. SPS for the diagnosis of CAD. Data of 10 studies comprising 651 patients from 10 different institutions were analyzed. DET dose was 0.56 mg/kg (low dose) in two studies, 0.75 mg/kg in 10 min or 0.84 mg/kg in 10 min (high-dose) in six studies, and 0.84 mg/kg in 6 min (accelerated high dose) in one study and 0.84 mg/kg in 10 min + 1 mg atropine co-administration (augmented dose) in one study. SPS was performed with dipyridamole in six studies, with exercise in three studies and with dobutamine in one study. Results: The overall diagnostic accuracy of the two tests was almost similar, 77% (95% CI = 74-81) for DET vs. 81% (95% CI = 78-84) for SPS (p = ns). SPS gave higher sensitivity, 88% (95% CI = 85-89) than DET, 70% (95% CI = 66-75) in cumulative data (p <0.0001) while DET gave higher specificity, 90% (95% CI = 86-94) vs. 67% (95% CI = 60-73) (p <0.0001). With state of the art protocols, i.e. accelerated dose and atropine augmented high dose, sensitivity of DET improved and overall accuracy was better than SPS (p <0.05). Conclusion: DET and SPS have a similar diagnostic accuracy. DET has a markedly higher specificity regardless of the dose employed. SPS shows a superior sensitivity, however this sensitivity gap diminishes when more aggressive dipyridamole dosage is used for the stress echocardiography.

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KW - Head-to-head comparison

KW - Meta-analysis

KW - Stress myocardial scintigraphy

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