Overall and Segmental Agreement of Stress Echocardiography

Several stress echocardiography (SE) modalities have been introduced for diagnosing coronary artery disease (CAD). Exercise and dobutamine SE are commonly considered to have a better diagnostic accuracy than vasodilator SE. The purpose of this study was to assess the agreement between the test results and the segmental concordance between three SE tests in patients with chest pain. A total of 60 patients (mean age, 55.1 years; SD, 2.1) were tested by symptom-limited bicycle (BSE), dipyridamole-atropine (DiASE), and dobutamine (DSE) tests. CAD (50% stenosis) was present in 44 patients, and 26 patients had one-vessel disease. In BSE and DSE, the double product at peak stress (26.5 and 16.1 vs 13.3 x 10(3), respectively, P < 0.005 vs DiASE) and the peak wall motion score index were higher than in DiASE (1.40 and 1.35 vs 1.26, respectively, P < 0.05 vs DiASE). BSE, DiASE, and DSE did not differ in sensitivity in diagnosing CAD (90%, 93%, and 95%, respectively). Similarly, there were no statistically significant differences in the diagnostic accuracy of BSE, DiASE, and DSE (78%, 88%, and 87%, respectively). The intermethod agreement was moderate between BSE and DiASE (kappa = 0.51), good between BSE and DSE (kappa = 0.62), and moderate between DiASE and DSE (kappa = 0.57). The segmental agreement between BSE, DiASE, and DSE was mostly moderate. Agreement was best between the pharmacologic tests due to test protocols, especially the anterior wall (kappa > 0.60). Also, the basal segments showed good agreement. In conclusion, BSE, DiASE, and DSE have a similar diagnostic accuracy in detecting CAD. The overall agreement between the tests was good, and the assessment of wall motion was variable. Nevertheless, concordant diagnosis of a patient can be obtained by BSE, DiASE, and DSE without loss of diagnostic power.