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.
Bibliographical noteFunding Information:
From the Hennepin County Medical Center and University of Min-nesota,a Minneapolis, MN; Midwest Heart Specialists,b Fox River Grove, IL; Princess Alexandra Hospital,c University of Queensland, Brisbane, QLD, Australia and University of Minnesota,d Minnea-polis, MN. Supported by grants from Hennepin Faculty Associates, the Minne-apolis Medical Research Foundation, and DuPont Pharmaceuticals. Received for publication Apr 30, 2008; final revision accepted Mar 3, 2009. Reprint requests: Bradley A. Bart, MD, FACC, Hennepin County Medical Center and University of Minnesota, O5 HCMC, 701 Park Avenue South, Minneapolis, MN 55415; firstname.lastname@example.org. 1071-3581/$34.00 Copyright © 2009 by the American Society of Nuclear Cardiology. doi:10.1007/s12350-009-9076-y
- Myocardial perfusion imaging: SPECT
- Pharmacologic stress