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Dobutamine stress echocardiography, Tc-99m radionuclide ventriculography (RNVG), and exercise stress testing were performed prospectively in 63 patients with suspected coronary artery disease to compare the values of exercise testing, dobutamine stress echocardiography and RNVG in the non-invasive diagnosis of coronary artery disease. The sensitivities of dobutamine stress echocardiography and RNVG were found to be higher than that of exercise testing (93-62%, p < 0.001; 83-62%, p < 0.05). The sensitivities of dobutamine stress echocardiography and RNVG were similar (p > 0.05). There were no differences between the sensitivities of the three techniques in multiple vessel disease (p > 0.05). The specificities of dobutamine stress echocardiography and RNVG were higher than that of exercise testing (for both of the tests 86-62%, p < 0.05). The diagnostic accuracy of dobutamine stress echocardiography and RNVG were similar (p > 0.05). The results of dobutamine stress echocardiography RNVG were concordant with each other in 46 patients (76%, kappa = 65%) in sectional analysis. Dobutamine stress echocardiography and RNVG tests were comparable with each other in 85% of the 189 segments (kappa = 64%). The expected 5% decrease at peak doses of dobutamine was not detected in stress echocardiography in 25 patients and in RNVG in 26 of the patients. Dobutamine stress echocardiography and RNVG are superior to exercise testing in the diagnosis of single vessel disease and there is no significant difference between the two techniques. When the ejection fraction is considered in dobutamine stress echocardiography and RNVG, it does not make an additional contribution to the diagnosis of coronary artery disease.

To compare the value of exercise electrocardiography with dobutamine stress echocardiography and exercise technetium-99m isonitrile single-photon emission computed tomography for coronary artery disease, 70 patients with either suspected or proven coronary artery disease underwent dobutamine stress echocardiography, exercise technetium-99m isonitrile single-photon emission computed tomography (mibi-SPECT) and treadmill exercise electrocardiography (ECG). Dobutamine echocardiography and exercise mibi-SPECT revealed a higher overall sensitivity than exercise testing (90 vs 57%, p < 0.001; 96 vs 57%, p < 0.001, respectively). Dobutamine stress echocardiography showed a higher specificity than both exercise mibi-SPECT and treadmill exercise electrocardiography (90 vs 71%, p > 0.05; 90 and 62% p < 0.05, respectively) but the difference between dobutamine stress echocardiography and exercise mibi-SPECT was not statistically significant. Diagnostic accuracy of dobutamine stress echocardiography and exercise mibi-SPECT was higher than that of exercise testing (90 vs 59%, p < 0.001; 89 vs 59%, p < 0.001, respectively). Dobutamine stress echocardiography and exercise mibi-SPECT have superiority over exercise testing in the diagnosis of coronary artery disease and dobutamine stress echocardiography is an alternative for exercise mibi-SPECT.

The object of our study was to compare the value of exercise stress testing with simultaneous dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography for the diagnosis of coronary artery disease. Sixty-nine patients with either suspected or proven coronary artery disease underwent simultaneous dobutamine technetium-99m isonitrile single-photon emission computed tomography and stress echocardiography, and treadmill exercise electrocardiography. Dobutamine echocardiography and technetium-99m isonitrile single-photon emission computed tomography revealed a higher overall sensitivity than exercise testing (94 vs 60%, P < 0.001), but dobutamine stress echocardiography showed a higher specificity than both technetium-99m isonitrile single-photon emission computed tomography and exercise testing (86 vs 64%, P < 0.05, for both tests). In addition, the diagnostic accuracy of dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography was higher than that of exercise testing (91 vs 61%, P < 0.001; 86 vs 61%, P < 0.001, respectively). Dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography are superior to exercise testing in the diagnosis of coronary artery disease, and dobutamine stress echocardiography can act as an alternative to technetium-99m isonitrile single-photon emission computed tomography.