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Vol. 110, No. 2, 2008
Issue release date: April 2008

Head-to-Head Comparison of Dobutamine Stress Echocardiography and Cardiac Computed Tomography for the Detection of Significant Coronary Artery Disease

Nixdorff U. · Küfner C. · Achenbach S. · Stilianakis N. · Voigt J.-U. · Flachskampf F.A. · Daniel W.G. · Ropers D.
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Objectives: Dobutamine stress echocardiography (DSE) and contrast-enhanced electron beam tomography (EBCT) both have the potential to noninvasively detect coronary artery disease (CAD). We compared the accuracy of both methods to detect significant CAD in a direct comparison. Methods: 79 patients (32 women, 47 men, mean age 62 years) who were admitted for coronary angiography due to suspected CAD were studied. By EBCT coronary calcification (CAC) as well as angiography (CTA) was assessed. Presence of significant CAD was assumed if the calcium score exceeded 400 or the contrast-enhanced images displayed significant lumen reduction. DSE was performed using a standard protocol (5–40 µg/kg/min dobutamine plus 0.25–1.0 mg atropine if necessary). DSE and EBCT were independently evaluated concerning the presence of signficant CAD. Results were compared to invasive, quantitative coronary angiography. Results: 6 patients (8%) in DSE and 2 patients (3%) in EBCT were unevaluable for various reasons and therefore excluded from further analysis. In the remaining 71 patients, 33 patients (46%) showed significant CAD. DSE demonstrated a sensitivity of 70% (23/33) and a specificity of 84% (32/38). EBCT showed a sensitivity of 91% (30/33) and a specificity of 74% (28/38). By combining DSE and EBCT sensitivity increased to 97% with a specificity of 63%. Conclusions: In a blinded comparison, DSE demonstrated lower sensitivity but higher specificity than EBCT for the detection of significant CAD. Sensitivity was improved by combining both modalities.

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  1. Achenbach S, Moshage W, Ropers D, Nossen J, Daniel WG: Value of electron-beam computed tomography for the non-invasive detection of high-grade coronary-artery stenoses and occlusions. N Engl J Med 1998;339:1964–1971.
  2. Agatston AS, Janowitz WR: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827–832.
  3. Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, Friedman JD, Kang X, Polk D, Hachamovitch R, Shaw L, Rozanski A: Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol 2004;44:923–930.
  4. Greenland P, Bonow RO, Brundlage BH, Budoff MJ, Eisenberg MJ, Grundy SM, Lauer MS, Post WS, Raggi P, Redberg RF, Rodgers GP, Shaw LJ, Taylor AJ, Weintraub WS: ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. J Am Coll Cardiol 2007;49:380–402.

    External Resources

  5. Hecht HS: Practice guidelines for electron beam tomography: a report of the Society of Atherosclerosis Imaging. Am J Cardiol 2000;86:705–706.
  6. Kajinami K, Seki H, Tabekoshi N, Mabuchi H: Non-invasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium exercise stress test results. J Am Coll Cardiol 1995;26:1209–1221.
  7. LaMont DH, Budoff MJ, Shavelle DM, Shavelle R, Brundage BH, Hagar JM: Coronary calcium scanning adds incremental value to patients with positive stress tests. Am Heart J 2002;143:861–867.
  8. Rumberger JA, Sheedy PF, Breen JF, Schwartz RS: Electron beam computed tomographic calcium score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 1997;29:1542–1548.
  9. O’Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, Pohost GM, Shaw LJ, Weintraub WS, Winters WL Jr, Forrester JS, Douglas PS, Faxon DP, Fisher JD, Gregoratos G: American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 2000;102:126–140.
  10. Schmermund A, Baumgart D, Sack S, Mohlenkamp S, Gronemeyer D, Seibel R, Erbel R: Assessment of coronary calcification by electron-beam computed tomography in symptomatic patients with normal, abnormal or equivocal exercise stress test. Eur Heart J 2000;21:1674–1682.
  11. Shavelle DM, Budoff MJ, LaMont DH, Shavelle R, Kennedy JM, Brundage BH: Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease. J Am Coll Cardiol 2000;36:32–38.
  12. Achenbach S, Ropers D, Kuettner A, Flohr T, Ohnesorge B, Bruder H, Theessen H, Karakaya M, Daniel WG, Bautz W, Kalender WA, Anders K: Contrast-enhanced coronary artery visualization by dual-source computed tomography – initial experience. Eur J Radiol 2006;57:331–335.
  13. Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S, Wintersperger B, Reiser M, Becker CR, Steinbeck G, Boekstegers P: Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography. J Am Coll Cardiol 2005;46:147–154.
  14. Rubinstein R, Halon DA, Gaspar T, Peled N, Schliamser JE, Yaniv N: Usefulness of 64-slice multi-detector computed tomography to improve diagnostic yield in patients with chest pain and negative or equivocal exercise treadmill tests (abstract). J Am Coll Cardiol 2006;47(suppl A):114A.
  15. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davies JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC Jr, Alpert JS, Gregoratos G, Anerson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO: ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography. J Am Soc Echocardiogr 2003;16:1091–1110.
  16. Giesler T, Lamprecht S, Voigt J-U, Ropers D, Pohle K, Ludwig J, Flachskampf FA, Daniel WG, Nixdorff U: Long-term follow-up after deferral of revascularisation in patients with intermediate coronary stenoses and negative dobutamine stress echocardiography. Heart 2002;88:645–646.
  17. Nixdorff U, Matschke C, Winklmaier M, Flachskampf FA, Ludwig J, Pohle K, Land M, Gefeller O, Daniel WG: Native tissue second harmonic imaging improves endocardial and epicardial border definition in dobutamine stress echocardiography. Eur J Echocardiogr 2001;2:52–61.
  18. Voigt J-U, Exner B, Schmiedehausen K, Huchzermeyer C, Reulbach U, Nixdorff U, Platsch G, Kuwert T, Daniel WG, Flachskampf FA: Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 2003;107:2120–2126.
  19. Ramakrishna G, Breen JF, Mulvagh SL, McCully RB, Pellikka PA: Relationship between coronary artery calcification detected by electron-beam computed tomography and abnormal stress echocardiography. J Am Coll Cardiol 2006;48:2125–2131.
  20. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, St John Sutton M, Stewart WJ: Recommendations for chamber quantification: a report form the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr 2005;18:1440–1463.
  21. Reiber JHC, Serruys PW, Kooijmann CJ, Wijn W, Slager CJ, Gerbrands JJ, Schuurbiers JC, den Boer A, Hugenholtz PG: Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantification of coronary cineangiograms. Circulation 1985;71:280–288.
  22. Rumberger JA, Behrenbeck T, Breen JF, Sheedy PF: Coronary calcification by electron beam computed tomography and obstructive coronary artery disease: a model for costs and effectiveness of diagnosis as compared with conventional cardiac testing methods. J Am Coll Cardiol 1999;33:453–462.
  23. Achenbach S: Current and future status on cardiac computed tomography imaging for diagnosis and risk stratification. J Nucl Cardiol 2005;12:703–713.
  24. Hendel RC, Patel MR, Kramer CM, Poon M, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Petersen ED, Wolk MJ, Allen JM, Patel MR: ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol 2006;48:1475–1497.
  25. Budoff MJ, Rasouli ML, Shavelle DM, Gopal A, Gul KM, Mao SS, Liu SH, McKay CR: Cardiac CT angiography (CTA) and nuclear myocardial perfusion imaging (MPI) – a comparison in detecting significant coronary artery disease. Acad Radiol 2007;14:252–257.
  26. Mertes H, Erbel R, Nixdorff U, Mohr-Kahaly S, Wolfinger D, Meyer J: Stress echocardiography: a sensitive method in diagnosis of coronary heart disease. Herz 1991;16:355–366.
  27. Budoff MJ, Diamond GA, Raggi P, Arad Y, Guerci AD, Callister TD, Berman D: Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation 2002;105:1791–1796.
  28. Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, Bruning R, Reiser M, Steinbeck G: Correlation of coronary calcification and angiographically documented stenosis in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol 2001;37:451–457.
  29. Schmermund A, Bailey KR, Rumberger JA, Reed JE, Sheedy RF 2nd, Schwartz RS: An algorithm for non-invasive identification of angiographic three-vessel and/or left main coronary artery disease in symptomatic patients on the basis of cardiac risk and electron-beam computed tomographic calcium scores. J Am Coll Cardiol 1999;33:444–452.
  30. Horiguchi J, Shen Y, Akiyama Y, Hirai N, Sasaki K, Ishifuro M, Ito K: Electron beam CT versus 16-slice spiral CT: how accurately can we measure coronary artery calcium volume? Eur Radiol 2006;16:374–380.
  31. Mori S, Kondo C, Suzuki N, Hattori A, Kusakabe M, Endo M: Volumetric coronary angiography using the 256-detector row computed tomography scanner: comparison in vivo and in vitro with porcine models. Acta Radiol 2006;47:186–191.
  32. Kuhl HP, Schreckenberg M, Rulands D, Katoh M, Schafer W, Schummers G, Bucker A, Hanrath P, Franke A: High-resolution transthoracic real-time three-dimensional echocardiography: quantitation of cardiac volumes and function using semi-automatic border detection and comparison with cardiac magnetic resonance imaging. J Am Coll Cardiol 2004;43:2083–2090.
  33. Bax JJ, Beanlands RS, Klocke FJ, Knuuti J, Lammertsma AA, Schaefers MA, Schelbert HR, von Schulthess GK, Shaw LJ, Yang GZ, Camici PG: Diagnostic and clinical perspectives of fusion imaging in cardiology: is the total greater than the sum of its parts? Heart 2007;93:16–22.

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