Selection of the optimal nonexercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion. Comparison of dobutamine and adenosine using echocardiography and 99mTc-MIBI single photon emission computed tomography.
Why the study?
Does dobutamine or adenosine stress provide better diagnostic accuracy when combined with echocardiography or SPECT in patients undergoing coronary angiography?
Population
97 consecutive patients without evidence of previous infarction undergoing coronary angiography for clinical…
Comparison
Dobutamine stress and Adenosine stress evaluated… vs Within-patient comparison.
Design
Cohort
Authors
Discussion
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Implication
Adenosine echocardiography may miss CAD; supports preferring dobutamine or perfusion imaging while leaving optimal protocols open for RCTs.
Structured PICO
Does dobutamine or adenosine stress provide better diagnostic accuracy when combined with echocardiography or SPECT in patients undergoing coronary angiography?
P
Population
97 consecutive patients without evidence of previous infarction undergoing coronary angiography for clinical indications.
I
Intervention
Dobutamine stress (5 to 40 micrograms.kg-1.min-1) and Adenosine stress (0.10, 0.14, and 0.18 mg.kg-1.min-1) evaluated with two-dimensional echocardiography (2DE) and 99mTc-MIBI SPECT.
C
Comparator
Within-patient comparison (each patient received both dobutamine and adenosine stress).
O
Outcome
Diagnostic sensitivity, specificity, and accuracy for detecting significant coronary disease (>50% stenosis in a major epicardial vessel).surrogate
Dobutamine stress is effective for both wall motion and perfusion imaging, whereas adenosine stress is best combined with perfusion scintigraphy rather than echocardiography.
Cite This Study
Marwick et al. (1993) studied this question.