Objectives: We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI) for the detection of intermediate versus severe coronary artery stenosis during dipyridamoleatropine echocardiography (DASE).
Background:
Wall motion (WM) assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD), particularly in patients with isolated intermediate (50%-70%) coronary stenosis.
Methods:
We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography.
Results:
When CAD was defined as the presence of a [greater than or equal to]50% stenosis, the addition of MPI increased sensitivity (+30%) and decreased specificity (-14%), with a final increase in total diagnostic accuracy (+16%, p<0.001). The addition of MPI data substantially increased the sensitivity to detect patients with isolated intermediate stenosis from 37% to 98% (p<0.001); the incremental sensitivity was much lower in patients with severe stenosis, from 85% to 96% (p<0.05), at the expense of a higher decrease in specificity and a final decrease in total diagnostic accuracy (-18%, p<0.001).
Conclusions:
The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition ([greater than or equal to]50% or >70% stenosis), but it is m0ainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis).The total diagnostic accuracy increased only when defining CAD as [greater than or equal to]50% stenosis, since in patients with severe stenosis (>70%) the decrease in specificity is not counterbalanced by the minor sensitivity increase.

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