Can Stress Echocardiography Compete with Perfusion Scintigraphy in the Detection of Coronary Artery Disease and Cardiac Risk Assessment?

Aims: The aim of this review was to define the place of stress echocardiography in the context of perfusion scintigraphy for the detection of coronary artery disease (CAD) and the assessment of cardiac risk. Stress echocardiography has the benefits of widespread availability, relatively low cost, portability, absence of radiation, and the determination of the ischaemic threshold. However, the echocardiographic windows are variable, sometimes with poor echogenicity, and interpretation is subjective and requires an adequate learning period. Methods and Results:Diagnostic and prognostic comparisons were focused on studies compari

Dobutamine Stress Test: its role in the diagnosis and functional evaluation of coronary artery disease

Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. High dose dobutamine in conjunction with echocardiography or myocardial perfusion scintigraphy was shown to have a good accuracy for the diagnosis and localization of coronary artery disease. Low-dose dobutamine echocardiography is of potential value in the identification of myocardial viability and the prediction of functional improvement of dyssynergic myocardium spontaneously or after revascularization. However, the clinical utility and limitations of dobutamine stress testing in the diagnosis of myocardial viability and ischemia in some clinical settings have not been investigated. The role of dobutamine stress echocardiography and myocardial perfusion scintigraphy in the diagnosis of peri-infarction ischemia has not been established. The influence of fixed wall motion and perfusion abnormalities on the occurrence of ischemic response in peri-infarction area in patients with infarct-related artery stenosis was not studied. Additionally, it is not known if observation of various changes in contractility from low to high-dose dobutamine may be provide data regarding myocardial viability and ischemia additional to those obtained only at low or high dose

The relationship between serum osteopontin level and parameters of Chronic Kidney Disease – mineral bone disease in patients on regular hemodialysis

Background: Chronic Kidney Disease (CKD) is becoming a major health concern worldwide. For many patients, CKD is associated with substantial morbidity and mortality. Osteopontin (OPN) is an extracellular matrix protein first identified in bone tissue and has pleiotropic functions due to its common expression in the main organs and apparatuses. It is a phosphorylated glycophosphoprotein composed of 314 amino acids, involved in biomineralization and remodeling.Objective: This research aimed to assess the serum level of osteopontin in patients with end-stage renal disease (ESRD) on regular haemodialysis and to correlate osteopontin level in patients with ESRD on hemodialysis with other biomarkers CKD-MBD.Patients & Methods: This Study was conducted on 160 participants that were divided into two groups. Control group included 80 healthy subjects of both sexes, and patients group that included 80 ESRD patients on regular hemodialysis of both sexes. All studied groups were subjected to osteopontin level by enzyme-linked immunosorbent assay (ELISA).Results: Serum osteopontin levels were higher in ESRD patients on regular dialysis than in healthy individuals, where it might have a higher predictive value for CKD development. Also, they were positively correlated with serum phosphorus, serum alkaline phosphatase and serum parathyroid hormone, which are parameters of chronic kidney disease-mineral and bone disorder.Conclusion: Osteopontin may be considered an early marker of chronic kidney disease

Long-term prognostic value of dobutamine stress echocardiography in patients with atrial fibrillation

STUDY OBJECTIVE: To assess the long-term prognostic value of dobutamine stress echocardiography (DSE) for cardiac events (cardiac death, myocardial infarction, and late revascularization) in patients with atrial fibrillation (AF). METHODS: Baseline ECGs were studied in patients undergoing DSE between 1989 and 1998. Sixty-nine patients had AF before DSE. Prognostic value of DSE in these patients was compared with a control group who had sinus rhythm (n = 1,664). The presence of stress-induced ischemia was noted for every patient. The mean follow-up period was 35 months (range, 6 to 84 months). Data are presented as hazards ratio (HR) with 95% confidence interval (CI). RESULTS: Heart rate at rest was higher in patients with AF (77 +/- 15 beats/min vs 73 +/- 14 beats/min; p = 0.04); however, double product at peak stress was not different between patients with AF and sinus rhythm (17,602 vs 17,169, respectively; p = 0.46). In patients with AF, target heart rate was achieved at a lower dobutamine dose (33 +/- 8 microg/kg/min vs 35 +/- 9 microg/kg/min; p = 0.01). Cardiac arrhythmias occurred more frequently (12% vs 5%; p = 0.001) in patients with AF during DSE. During a follow-up period of 7 years, cardiac death occurred in 5 patients, myocardial infarction in 2 patients, and late revascularization in 10 patients. Prognostic value of DSE for all late cardiac events was similar in patients with AF (HR, 3.0; 95% CI, 0.9 to 9.5) and sinus rhythm (HR, 3.4; 95% CI, 2.7 to 4.3; p = 0.85). CONCLUSION: The prognostic value of DSE for late cardiac events is maintained in patients with AF

Noninvasive diagnosis of coronary artery stenosis in women with limited exercise capacity: comparison of dobutamine stress echocardiography and 99mTc sestamibi single-photon emission CT

OBJECTIVES: To compare the accuracy of dobutamine stress echocardiography (DSE) and simultaneous 99mTc sestamibi (MIBI) single-photon emission CT (SPECT) imaging for the diagnosis of coronary artery stenosis in women. PATIENTS: Seventy women with limited exercise capacity referred for evaluation of myocardial ischemia. METHODS: DSE (up to 40 microg/kg/min) was performed in conjunction with stress MIBI SPECT. Resting MIBI images were acquired 24 h after the stress test. Ischemia was defined as new or worsened wall motion abnormalities confirmed by DSE and as reversible perfusion defects confirmed by MIBI. Significant coronary artery disease was defined as > or = 50% luminal diameter stenosis. RESULTS: DSE was positive for ischemia in 35 of 45 patients with coronary artery stenosis and in 2 of 25 patients without coronary artery stenosis (sensitivity = 78% CI, 68 to 88; specificity = 92% CI, 85 to 99; and accuracy = 83% CI, 74 to 92). A positive MIBI study for ischemia occurred in 29 patients with coronary artery stenosis and in 7 patients without coronary artery stenosis (sensitivity = 64% CI, 53 to 76; specificity = 72% CI, 61 to 83; and accuracy = 67% CI, 56 to 78 [p < 0.05 vs DSE]). In the 59 vascular regions with coronary artery stenosis, the regional sensitivity of DSE was higher than MIBI (69% CI, 62 to 77 vs 51% CI, 42 to 59, p < 0.05), whereas specificity in the 81 vascular regions without significant stenosis was similar (89% CI, 84 to 94 vs 88% CI, 82 to 93, respectively). CONCLUSION: DSE is a useful noninvasive method for the diagnosis of coronary artery stenosis in women and provides a higher overall and regional diagnostic accuracy than dobutamine MIBI SPECT in this particular population

Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

Stress echocardiography and myocardial perfusion imaging are commonly used noninvasive imaging modalities for the evaluation of ischaemic heart disease. Both modalities have proved clinically useful in the entire spectrum of coronary artery disease. Both techniques can detect coronary artery disease and provide prognostic information. Both techniques can identify low-risk and high-risk subsets among patients with known or suspected coronary artery disease and thus guide patient management decisions. In patients with acute myocardial infarction, both techniques have been used to identify residual viable tissue and predict improvement of function over time. In patients with chronic ischaemic left ventricular (LV) dysfunction, viability assessment with either modality can be used to predict improvement of function after revascularisation and thus guide patient treatment