Journal of the American Society of Echocardiography
Clinical InvestigationCAD-Stress EchocardiographyFactors Affecting Sensitivity and Specificity of Diagnostic Testing: Dobutamine Stress Echocardiography
Section snippets
Literature Review
A Medline search for diagnostic dobutamine stress echocardiographic studies published up to 2006 using the terms “dobutamine stress” and “coronary artery disease” was performed. In addition, we reviewed the reference lists of review articles and eligible studies to complete the data search. Excluded from this search were reports solely on patients with poor echocardiographic windows, left bundle branch block, hypertension, and/or left ventricular hypertrophy or prior myocardial infarction. To
Sensitivities and Specificities
For the 62 unique study groups in the 60 reports, 6881 patients were studied with DSE and coronary angiography with sufficient data to record sensitivity and specificity. Of these, 4718 had angiographic CAD, whereas 2163 did not. A total of 3882 patients had true-positive findings on DSE, resulting in a sensitivity of 0.812. There were 1790 true-negative findings, resulting in a specificity of 0.822. Sensitivities and specificities for each of the 62 study groups are reported in Table 2.
Effects of Patient Characteristics
The
Discussion
This meta-analysis indicates that patient characteristics, referral bias, and technical factors (such as the definition of positive results on DSE) all significantly affect the reported sensitivity and specificity of DSE.
References (82)
- et al.
Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography
J Am Coll Cardiol
(1997) - et al.
Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms
J Am Coll Cardiol
(1996) - et al.
Factors affecting sensitivity and specificity of exercise electrocardiography. Multivariable analysis
Am J Med
(1984) - et al.
Factors affecting sensitivity and specificity of a diagnostic test: the exercise thallium scintigram
Am J Med
(1988) - et al.
Dobutamine stress echocardiography: sensitivity, specificity, and predictive value for future cardiac events
Am Heart J
(1994) - et al.
Real-time three-dimensional dobutamine stress echocardiography in assessment stress echocardiography in assessment of ischemia: comparison with two-dimensional dobutamine stress echocardiography
J Am Coll Cardiol
(2001) - et al.
Stress echocardiography in elderly patients with coronary artery disease: applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients
J Am Coll Cardiol
(1996) - et al.
Application of tissue Doppler to interpretation of dobutamine echocardiography and comparison with quantitative coronary angiography
Am J Cardiol
(2001) - et al.
Dobutamine digital echocardiography for detecting coronary artery disease
Am J Cardiol
(1991) - et al.
Stress echocardiography: comparison of exercise, dipyridamole and dobutamine in detecting and predicting the extent of coronary artery disease
J Am Coll Cardiol
(1995)
Incremental diagnostic value of dobutamine stress echocardiography and dobutamine scintigraphy (technetium 99m-labeled sestamibi single-photon emission computed tomography) for assessment of presence and extent of coronary artery disease
J Nucl Cardiol
The value of dobutamine stress echocardiography for the detection of coronary artery disease in women
J Am Soc Echocardiogr
Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease
J Am Coll Cardiol
Effect of tissue Doppler on the accuracy of novice and expert interpreters of dobutamine echocardiography
Am J Cardiol
Dobutamine stress echocardiography in the detection of coronary artery disease: importance of the pretest likelihood of disease
Am Heart J
Comparative evaluation of bicycle and dobutamine stress echocardiography with perfusion scintigraphy and bicycle electrocardiogram for identification of coronary artery disease
Am J Cardiol
Dobutamine stress echocardiography in women with chest pain. Pilot phase data from the National Heart, Lung and Blood Institute Women's Ischemia Syndrome Evaluation (WISE)
J Am Coll Cardiol
Atropine augmentation in dobutamine stress echocardiography: role and incremental value in a clinical practice setting
J Am Coll Cardiol
Comparison of bicycle, heavy isometric, dipyridamole-atropine and dobutamine stress echocardiography for diagnosis of myocardial ischemia
Am J Cardiol
Accuracy of dobutamine stress echocardiography in detecting coronary artery disease
Am J Cardiol
Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography or scintigraphy, or both?
J Am Coll Cardiol
Value of rapid beta-blocker injection at peak dobutamine-atropine stress echocardiography for detection of coronary artery disease
J Am Coll Cardiol
Dobutamine stress echocardiography for detection and assessment of coronary artery disease
J Am Coll Cardiol
Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography
Am J Cardiol
Echo Persantine (EPIC) and Echo Dobutamine International Cooperative (EDIC) Study Groups. The atropine factor in pharmacologic stress echocardiography
J Am Coll Cardiol
Comparison of dobutamine stress echocardiography, dipyridamole stress echocardiography and exercise stress testing for diagnosis of coronary artery disease
Am J Cardiol
Dobutamine stress echocardiography: clinical utility and predictive value at various infusion rates
Am Heart J
Head-to-head comparison of exercise stress testing, pharmacologic stress echocardiography, and perfusion tomography as first-line examination for chest pain in patients without history of coronary artery disease
J Nucl Cardiol
Synergistic value of simultaneous stress dobutamine sestamibi single- photon-emission computerized tomography and echocardiography in the detection of coronary artery disease
Am Heart J
Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: limitations and concordance
J Am Coll Cardiol
Dobutamine and dipyridamole stress echocardiography in patients with a low incidence of severe coronary artery disease
J Am Soc Echocardiogr
Second harmonic imaging improves sensitivity of dobutamine stress echocardiography for the diagnosis of coronary artery disease
Am Heart J
Long-term prognostic significance of dobutamine echocardiography in patients with suspected coronary artery disease: results of a 5-year follow-up study
J Am Coll Cardiol
On-line quantitative assessment of left ventricular filling during dobutamine stress echocardiography: a useful addition to conventional wall motion scoring
Int J Cardiol
Comparison of dobutamine stress echocardiography with and without real-time perfusion imaging for detection of coronary artery disease
Am J Cardiol
Influence of wall stress and left ventricular geometry on the accuracy of dobutamine stress echocardiography
J Am Coll Cardiol
Quantitative angiographic measurements of isolated left anterior descending coronary artery stenosis. Correlation with exercise echocardiography and technetium-99m 2-methoxy isobutyl isonitrile single-photon emission computed tomography
J Am Coll Cardiol
Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine- atropine stress test
J Am Coll Cardiol
Integrated evaluation of relation between coronary lesion features and stress echocardiography results: the importance of coronary lesion morphology
J Am Coll Cardiol
Impact of severity of coronary artery stenosis and the collateral circulation on the functional outcome of dyssynergic myocardium after revascularization in patients with healed myocardial infarction and chronic left ventricular dysfunction
Am J Cardiol
Effect of beta-blockade on dobutamine stress echocardiography
Am Heart J
Cited by (52)
Screening Modalities for Coronary Artery Disease in Liver Transplant Candidates: A Review of the Literature
2023, Journal of Cardiothoracic and Vascular AnesthesiaGlobal Myocardial Work Combined with Treadmill Exercise Stress to Detect Significant Coronary Artery Disease
2022, Journal of the American Society of EchocardiographyPreoperative Cardiac Risk Assessment
2020, Mayo Clinic ProceedingsSpecific Challenges in Conducting and Reporting Studies on the Diagnostic Accuracy of Ultrasonography in Bovine Medicine
2016, Veterinary Clinics of North America - Food Animal PracticeNonexercise Stress Echocardiography for Diagnosis of Coronary Artery Disease
2016, Practice of Clinical EchocardiographyQuantitative Dobutamine Stress Echocardiography Using Speckle-Tracking Analysis versus Conventional Visual Analysis for Detection of Significant Coronary Artery Disease after ST-Segment Elevation Myocardial Infarction
2015, Journal of the American Society of EchocardiographyCitation Excerpt :However, the postinfarct setting presents significant challenges to accurate conventional dobutamine stress echocardiographic analysis, principally because of the presence of existing wall motion abnormalities which add an increased level of complexity to interpretation. Previous meta-analyses have shown considerable variability in the sensitivity of DSE for the prediction of multivessel disease, reported as between 8% and 71%.3,25 In the present analysis, in which more than half (52%) of our population had abnormal wall motion at rest, the sensitivity of conventional wall motion analysis was correspondingly poor.