Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy.
Am J Cardiol. 2010 May 1;105(9):1254-60. doi: 10.1016/j.amjcard.2009.12.033. Epub 2010 Mar 11.
To assess the performance of currently used stress tests for the detection of coronary artery disease (CAD) in a series of female hypertensive patients. We performed exercise electrocardiography (ECG), technetium-99m sestamibi (MIBI) single photon emission computed tomography, dobutamine and dipyridamole echocardiography, and coronary angiography in 76 hypertensive women. Of the 76 study patients, 31 (41%) had significant CAD. The sensitivity of exercise ECG (81%), MIBI scanning (90%), and dobutamine echocardiography (87%) was greater than that of dipyridamole echocardiography (61%). This finding resulted from the lower sensitivity of dipyridamole echocardiography in the detection of single-vessel CAD (47% vs 76%, 88%, and 82% for the other 3 methods). In contrast, the sensitivity of the 4 tests was similar in the detection of multivessel CAD. The specificity of exercise ECG (56%) and MIBI scanning (53%) was less than that of dobutamine (82%, both p <0.01) and dipyridamole (91%, both p <0.001) echocardiography. This finding related to the lower specificity of exercise ECG in patients with either left ventricular hypertrophy or ST-T abnormalities at rest compared to the specificity in patients without these disorders (33% vs 89%, p <0.01). A lower MIBI scan specificity was found only in patients with left ventricular hypertrophy (31% vs 66%, p <0.05). The overall accuracy of dobutamine echocardiography reached 84% compared to exercise ECG (66%, p <0.01), MIBI scan (68%, p <0.05), and dipyridamole echocardiography (79%, p <0.05). In conclusion, dobutamine echocardiography yielded satisfactory diagnostic accuracy for identifying CAD in hypertensive women. Although dipyridamole echocardiography had the greatest specificity, it might be limited in detecting mild CAD. Both exercise ECG and MIBI scanning had fare sensitivity; however, our findings limit the usefulness of these 2 tests in unselected patients.
评估一系列女性高血压患者中目前用于检测冠状动脉疾病（CAD）的应激试验的性能。我们对 76 名高血压女性进行了运动心电图（ECG）、锝-99m sestamibi（MIBI）单光子发射计算机断层扫描、多巴酚丁胺和双嘧达莫超声心动图以及冠状动脉造影。在 76 名研究患者中，31 名（41%）有明显的 CAD。运动心电图（81%）、MIBI 扫描（90%）和多巴酚丁胺超声心动图（87%）的敏感性高于双嘧达莫超声心动图（61%）。这一发现是由于双嘧达莫超声心动图检测单支血管 CAD 的敏感性较低（47%与 76%、88%和 82%，其他 3 种方法）。相比之下，4 种试验在检测多支血管 CAD 时的敏感性相似。运动心电图（56%）和 MIBI 扫描（53%）的特异性低于多巴酚丁胺（82%，均 p<0.01）和双嘧达莫（91%，均 p<0.001）超声心动图。这一发现与运动心电图在休息时存在左心室肥厚或 ST-T 异常的患者中的特异性低于无这些疾病的患者有关（33%与 89%，p<0.01）。仅在存在左心室肥厚的患者中发现 MIBI 扫描特异性较低（31%与 66%，p<0.05）。多巴酚丁胺超声心动图的总体准确性达到 84%，高于运动心电图（66%，p<0.01）、MIBI 扫描（68%，p<0.05）和双嘧达莫超声心动图（79%，p<0.05）。总之，多巴酚丁胺超声心动图在识别高血压女性中的 CAD 方面具有令人满意的诊断准确性。虽然双嘧达莫超声心动图具有最大的特异性，但它可能在检测轻度 CAD 方面受到限制。运动心电图和 MIBI 扫描都具有良好的敏感性；然而，我们的发现限制了这两种测试在未选择患者中的有用性。
