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 comparing stress (exercise, dobutamine, adenosine or dipyridamole) echocardiography and perfusion scintigraphy in the same patients. These direct diagnostic comparisons (22 studies for a total of 1380 patients) show that stress echocardiography may be somewhat less sensitive in detecting and localizing mild CAD (in particular when vasodilators are used), but is more specific than perfusion scintigraphy. The direct prognostic comparisons (five studies for a total of 805 patients) show that stress echocardiography and perfusion scintigraphy have comparable prognostic value. CONCLUSIONS At this moment, stress echocardiography already seems very competitive with perfusion scintigraphy. In the near future, improvement in endocardial border detection and quantitation of wall motion analysis are expected to improve the value of stress echocardiography still further.