Dobutamine stress echocardiography: initial experience of a Canadian centre.
OBJECTIVE
To investigate the diagnostic accuracy, electrocardiogram and hemodynamic effects and safety of dobutamine stress echocardiography.


METHODS
Sixty-one patients with suspected coronary artery disease. All patients underwent coronary arteriography.


RESULTS
The sensitivity of dobutamine stress echocardiography in diagnosis of coronary artery disease in the whole group was 91%. In patients with left anterior descending it was 97%; right 85%; circumflex 76%; three vessel 100%; two vessel 95%; single vessel 77%. Specificity, positive predictive value and accuracy of dobutamine stress echocardiography in diagnosis of coronary disease (whole group) was 57, 94 and 87%, respectively. ST depression of more than 1 mm occurred in 11 patients, ST elevation of more than 1 mm in three patients, T wave inversion in one and T normalization in nine. Significant differences of the effects of beta-blockers were noted on the peak effects of dobutamine as follows: heart rate increase of 46 +/- 22 versus 20 +/- 13 beats/min (P less than 0.0001); systolic pressure increase of 4 +/- 26 versus 22 +/- 19 mmHg (P less than 0.01); diastolic pressure decrease of 18 +/- 16 versus 10 +/- 12 mmHg (P less than 0.03) for patients without or with beta-blockers, respectively. Unifocal ventricular premature beats were noted in 10 patients, atrial premature beats in five and ventricular couplets in one. Angina occurred in 11 patients. Atypical chest pain occurred in seven patients, tingling in 11 and nausea in four. Thirty-six patients were totally asymptomatic.


CONCLUSIONS
In this population with high prevalence (85%) of coronary artery disease, dobutamine stress echocardiography had high sensitivity and positive predictive value for coronary disease detection particularly in patients with left anterior descending or three vessel disease. The specificity and accuracy were not as good, but this may reflect the small number of normal patients. Dobutamine was well tolerated and conveniently administered.
Epstein
M
M
Department of Medicine, Vancouver General Hospital, British Columbia.
Gin
K
K
Sterns
L
L
Pollick
C
C
D000328:Adult; D000368:Aged; D002932:Cineangiography; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000494:pharmacology; D004452:Echocardiography / Q000187:drug effects / Q000379:methods*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
D004280:Dobutamine