Key Points
- To compare the diagnostic performance and regional defect detection of simultaneous exercise echocardiography and thallium-201 SPECT in patients being evaluated for coronary artery disease.
- Simultaneous exercise echocardiography and 201Tl SPECT were performed during treadmill testing in N=292 patients (adequate diagnostic echocardiograms obtained in N=289).
- Left ventricular wall motion and perfusion were categorized across anterior, inferior, and lateral regions as totally reversible, fixed, or partially reversible abnormalities.
- Diagnostic sensitivity and specificity were evaluated against coronary angiography (defining significant disease as ≥50% diameter stenosis) in a subset of 112 patients.
- Exercise echocardiography and SPECT showed an overall patient agreement of 88% (both normal in 137, both abnormal in 118) and an 82% agreement for specific regional defect types.
- Against angiography, sensitivity for one-vessel disease was 58% for echocardiography versus 61% for SPECT, and both reached 94% sensitivity for three-vessel disease.
- Specificity for coronary artery disease was 88% for exercise echocardiography and 81% for 201Tl SPECT, with combined testing detecting a greater total number of abnormal regions.
Structured PICO
Does exercise echocardiography have comparable diagnostic accuracy to 201Tl SPECT in evaluating coronary artery disease?
PPopulation292 patients being evaluated for coronary artery disease
IInterventionExercise echocardiography (digital cine-loop technique)
CComparator201Tl single-photon emission computed tomography (SPECT)
OOutcomeDiagnostic accuracy (sensitivity and specificity) for coronary artery disease compared to angiographysurrogate
Exercise echocardiography has comparable diagnostic accuracy to 201Tl SPECT for detecting regional abnormalities produced by significant coronary artery disease.