0
Letters |

Exercise Echocardiography vs Exercise SPECT Testing

James H. O'Keefe, Jr, MD; Timothy M. Bateman, MD; Raymond J. Gibbons, MD
JAMA. 1999;282(17):1621-1623. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-17-jbk1103.
Text Size: A A A
Published online

Extract

To the Editor: In their meta-analysis, Dr Fleischmann and colleagues1 reported that exercise ECHO has better specificity and therefore higher overall discriminatory capability than exercise SPECT imaging. We believe these conclusions are flawed for several important reasons.

The reference standard in all of the studies included in the meta-analysis was a stenosis of 50% to 70% on coronary angiography. This criterion standard is widely recognized to be poorly reproducible with a high degree of interobserver and intraobserver variability.2 Studies have shown that assessment of coronary flow reserve by cardiac catheterization is a much more accurate criterion than is luminal diameter stenosis. Impaired coronary vasodilatory reserve corresponds to a reversible myocardial perfusion defect with a 93% predictive accuracy.3 In contrast, angiographically determined stenosis severity is only loosely related to coronary flow reserve, especially in stenoses in the range of 50% to 80%. Many "false" positives found by SPECT (when using angiography as the criterion standard) are "true" positives when assessed by coronary flow-reserve measurement.

Topics

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();