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COMPARATIVE DIAGNOSTIC VALUE OF EXERCISE ELECTROCARDIOGRAPHY, TC-99M MIBI SPECT AND DOBUTAMINE ECHOCARDIOGRAPHY IN DETECTING CORONARY ARTERY DISEASE IN WOMEN.
M. Wierzchowiecki, A. Nowicka, K. Szymanowska, S. Ożegowski, M. Michalski, A. Sieńko, J. Sowiński1
II Dep. of Cardiology, Dept of Endocrynology1 Karol Marcinkowski University School of Medical Sciences, Poznań, Poland.
Background: The noninvasive diagnosis of coronary artery disease (CAD) in women remains a difficult clinical problem. The aim of this study was to compare usefulness of exercise electrocardiography (ExT), Tc-99m-labeled MIBI Single Photon Emission Computed Tomography (SPECT) and dobutamine echocardiography (E-DOB) in the diagnosis of CAD in women.
Methods: 41 consecutive women age 38-65 (mean 53 ± 6 years) with angina-like chest pain and no previous history of CAD, referred to coronary angiography were subjected to the study. Treadmill ExT with symptom limited exercise was performed according to modified Bruce protocol, Tc-99m MIBI SPECT during administration of 0.56 mg/kg of dipyridamole and E-DOB during infusion of increasing up to 40 m/kg/min doses of dobutamine. In all patients coronary angiography was also done.
Results: Significant coronary artery stenosis (>50% diameter narrowing) in coronary angiography was found in 18 pts. In 16 of them single-vessel disease was detected.



ExT had a sensivity of 66%, a specificity of 39% and an accuracy of 51%. E-DOB had a sensivity of 56%, a specificity of 74% and an accuracy of 66%. Finally MIBI-SPECT had a sensivity of 83%, specificity of 57% and accuracy of 68%. The tests did not differ significantly from each other in all estimated parameters. Conclusions: ExT has an acceptable sensivity with low specificity and accuracy. E-DOB and MIBI-SPECT are superior to ExT with better sensitivity for MIBI-SPECT and specificity for E-DOB; both tests possess satisfactory diagnostic accuracy.


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