Copyright 1999 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To the Editor: Dr Fleischmann and colleagues1 review selected literature to compare the diagnostic
performance of exercise echocardiography (ECHO) and single-photon emission
computed tomography (SPECT) in the diagnosis of coronary artery disease (CAD).
However, of the 44 listed articles, the 6 directly comparing exercise ECHO
and exercise SPECT were published prior to 1995. Articles appearing in the
literature since then are not discussed. O'Keefe et al,2
in their review of more than 75 published studies involving more than 7000
patients, also compared noninvasive cardiac exercise imaging modalities. They
found that exercise SPECT was more sensitive than exercise ECHO for detecting
CAD, localizing it to the proper artery distribution and correctly identifying
the presence of multivessel CAD. The use of pharmacological stress agents,
including adenosine, dipyridamole, and dobutamine, provided similar diagnostic
accuracy in conjunction with SPECT scintigraphy and were all more accurate
then dobutamine ECHO. They also found that clinical specificity was comparably
high with adenosine SPECT, dipyridamole ECHO, and exercise ECHO. A review
by Bonow3 stresses that SPECT provides greater
sensitivity in detecting the presence and severity of physiologically significant
CAD and the identification of dysfunctional, but viable, myocardium.
Dickinson CZ, Dworkin HJ. Exercise Echocardiography vs Exercise SPECT Testing. JAMA. 1999;282(17):1621–1623. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-17-jbk1103
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