Comparison of dobutamine stress echocardiography, dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging in patients with end-stage renal disease

Bradley A. Bart, Ye Ying Cen, Robert C. Hendel, Ramond Lee, Thomas H. Marwick, Emil D. Missov, Fouad A. Bachour, Charles A. Herzog

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Objectives: We sought to assess and compare the diagnostic accuracy and prognostic value of dobutamine stress echocardiography (DSE), dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging (MPI) in patients with end-stage renal disease (ESRD). Background: The optimal stress imaging modality for patients with ESRD has not yet been determined. Methods: Forty-nine patients with ESRD underwent DSE, dobutamine SPECT MPI, and adenosine SPECT MPI. The primary endpoint of the trial was concordance between stress tests with respect to the presence or absence of ischemia. Results: Agreement on the presence or absence of ischemia between adenosine SPECT MPI and DSE was 69% (kappa= .25, P = NS). Agreement on the presence or absence of ischemia between adenosine and dobutamine SPECT MPI was 77% (kappa = .37, P = <.009). Summed stress scores for adenosine and dobutamine SPECT MPI studies were highly correlated (r = .9, P = <.0001). DSE and SPECT MPI results provided incremental prognostic information when added to clinical variables. Conclusions: There is moderate concordance between DSE and adenosine SPECT MPI in ESRD patients referred for stress testing. Interobserver agreement was higher for SPECT MPI compared to DSE. Based on these observations, the optimal approach for diagnosing severe coronary artery disease and assessing risk in patients with ESRD has yet to be determined, but appears to warrant further investigation.

Original languageEnglish (US)
Pages (from-to)507-515
Number of pages9
JournalJournal of Nuclear Cardiology
Volume16
Issue number4
DOIs
StatePublished - Apr 8 2009

Keywords

  • Adenosine
  • Dobutamine
  • Echocardiography
  • Myocardial perfusion imaging: SPECT
  • Pharmacologic stress

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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