BACKGROUND The optimal approach for the detection of coronary artery disease (CAD) in asymptomatic individuals remains unclear. OBJECTIVES To evaluate the diagnostic performance of myocardial perfusion scintigraphy (MPS) and stress echocardiography (SE) in detecting CAD, and to assess the incremental diagnostic gain of the combination of these two tests in a clinical setting. METHODS The study was conducted in a tertiary care center from November 2001 to March 2002. Patients with a normal treadmill exercise stress test and a negative myocardial perfusion scan were included in the test-negative group. Patients with a history of CAD or known CAD were considered positive for myocardial ischemia or infarction. Fifty-three patients with a low likelihood for CAD underwent myocardial perfusion scintigraphy and stress echo. Based on coronary angiography, the test-negative group comprised 17 patients with normal coronary arteries, 6 with one vessel disease, 6 with two vessel disease, 5 with three vessel disease and 15 with multivessel disease. Of the 53 patients, 23 (43%) had a positive stress echocardiogram and 26 (49%) had a positive myocardial perfusion scintigraphy. The combined test was positive in 53% of patients with multivessel disease and in 28% of patients with single-vessel disease. A total of 54 segments were evaluated for both test modalities. Among the 53 patients, a total of 5 segments showed ischemia in the scintigraphic images, while 19 segments were ischemic in the echocardiographic images. Combined testing increased the detection of CAD to 72% compared to 59% with myocardial perfusion scintigraphy alone and 70% compared to 53% with stress echocardiography alone. CONCLUSIONS Stress echocardiography and myocardial perfusion scintigraphy are complementary testing modalities for detecting coronary artery disease in a clinical setting. The combination of the two tests is superior to either test alone in detecting CAD in patients with a low likelihood for CAD. PMID:19262292
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