The comparable diagnostic accuracies of dobutamine-stress and dipyridamole-stress echocardiographies: a meta-analysis

BACKGROUND: Dobutamine-stress and dipyridamole-stress echocardiographies are widely used for pharmacological stress echocardiography, with wide geographical variations. OBJECTIVE: To assess whether evidence derived from the literature indicates or disapproves that either stress modality confers diagnostic superiority. METHODS: We performed a meta-analysis of peer-reviewed literature of published trials with head-to-head comparison, on the same population, of high-dose (0.84 mg/kg) dipyridamole-stress versus high-dose (up to 40 micrograms/kg per min) dobutamine-stress echocardiography. Data from 12 studies performed in 12 institutions in seven countries were analysed. Angiographic information about 818 patients was considered. RESULTS: The diagnostic accuracies of the two tests were similar (631 of 818, 77%, for dipyridamole versus 654 of 818, 80%, for dobutamine, NS). Overall sensitivities were 403 of 568 (71%) for dipyridamole and 437 of 568 (77%) for dobutamine (P < 0.05). Sensitivities for patients with single-vessel disease were 177 of 275 (64%) for dipyridamole and 203 of 275 (74%) for dobutamine (P < 0.05). Sensitivities for patients with multivessel disease were 162 of 203 (80%) for dipyridamole and 163 of 203 (80%) for dobutamine (NS). Specificities were 232 of 250 (93%) for dipyridamole and 217 of 250 (87%) for dobutamine (P < 0.05). Data from an additional 26 studies with dipyridamole alone and 47 studies with dobutamine alone were analysed. The diagnostic accuracies were 80% for dipyridamole (n = 2038 patients; 95% confidence interval 75-82%) and 82% for dobutamine (n = 4264 patients; 95% confidence interval 79-84%). CONCLUSION: High-dose dobutamine-stress and high-dose dipyridamole-stress echocardiographies have comparable diagnostic accuracies, with a slightly higher sensitivity with dobutamine and a slightly higher specificity with dipyridamole.