From the Guidelines
Stress test specificity typically ranges from 73% to 89%, with the highest specificity observed in nuclear myocardial perfusion imaging approaches such as SPECT and PET. The specificity of stress tests can vary depending on the type of test used, with exercise SPECT, vasodilator SPECT, and PET approaches having specificities ranging from 73% to 89% for detecting coronary artery stenoses ≥50% 1. In contrast, stress echocardiography has specificities ranging from 44% to 100% for detecting coronary artery stenoses ≥50%, with the diagnostic accuracy reduced in patients with limited acoustic windows and poor image quality 1. Some key factors that can influence the specificity of stress tests include:
- Left ventricular hypertrophy
- Electrolyte abnormalities
- Certain medications
- Baseline ECG abnormalities
- Patient population, with women often having lower specificity than men due to smaller heart size and breast tissue attenuation 1. The clinical implication of this moderate specificity is that positive stress test results often require additional confirmation with coronary angiography to avoid unnecessary interventions based on false positive results. Specificity tends to be higher in populations with higher disease prevalence, making stress testing more valuable in patients with intermediate pre-test probability of coronary artery disease 1. It is essential to consider these factors and the specific test characteristics when interpreting stress test results to ensure accurate diagnosis and appropriate management of patients with suspected coronary artery disease.
From the FDA Drug Label
The specificity (true negative divided by the number of patients with negative angiograms) was about 50% The specificity of a stress test using thallium-201 is about 50% 2.
From the Research
Stress Test Specificity
- The specificity of dobutamine stress echocardiography has been reported to be around 80-83% in various studies 3, 4, 5.
- A study published in the Journal of the American College of Cardiology found that the specificity of dobutamine stress echocardiography was 83%, compared to 67% for perfusion scintigraphy 5.
- Another study published in the European Heart Journal found that dobutamine stress echocardiography had a specificity of 80% in detecting coronary artery disease 4.
- The specificity of dobutamine stress electrocardiography has been reported to be around 83% in one study, with an optimal criterion for positivity being an ST segment shift of 0.5 mm 80 ms after the J point 6.
Factors Affecting Specificity
- The presence of left ventricular hypertrophy has been found to affect the specificity of dobutamine stress echocardiography, with a higher specificity reported in patients with this condition 5.
- The use of selective scintigraphy in patients with a negative submaximal stress echocardiogram has been found to enhance the accuracy of stress echocardiography alone 5.
Comparison with Other Tests
- Dobutamine stress echocardiography has been compared to other tests such as exercise electrocardiography and perfusion scintigraphy, with similar levels of accuracy reported 3, 5.
- The sensitivity and specificity of dobutamine stress echocardiography have been found to be comparable to those of tomographic perfusion imaging 3.