title: Dobutamine and dipyridamole stress echocardiography in patients with a low incidence of severe coronary artery disease.
abstract: The aim of this study was to determine the relative sensitivity, specificity, accuracy, and tolerance of dobutamine and dipyridamole stress echocardiography in patients with a lower likelihood of severe coronary artery disease. Previous comparative studies, which included patients with a history of myocardial infarction or a high incidence of coronary artery disease, showed both methods to have similar and acceptable diagnostic accuracy. To assess the role of these agents in evaluating patients with a lower likelihood of significant coronary artery disease, a lower-risk group was selected by excluding patients with known coronary artery disease, myocardial infarction, unstable angina, or strongly positive stress test results. Dobutamine and dipyridamole stress echocardiographic studies were performed in random order, before coronary angiography. Of the 46 patients enrolled (31 men and 15 women), 24 had atypical chest pain or none at all. Coronary angiography revealed no significant disease in 22 (48%), single-vessel disease in 11 (24%), and multivessel disease in only 13 patients (28%). Dobutamine and dipyridamole stress echocardiography were equally well tolerated, with identical accuracy (76%) that was maintained in patients with atypical symptoms. This confirms the usefulness of both dobutamine and dipyridamole stress echocardiography in evaluating patients with suspected coronary artery disease and extends this role to a lower-risk group for severe disease who often have atypical symptoms. The choice of which agent is used should reflect an institution's experience.
authors.affiliation: University of Ottawa Heart Institute, Ontario, Canada.
authors.forename: R A
authors.initials: RA
authors.lastname: Sochowski
authors.forename: K J
authors.initials: KJ
authors.lastname: Yvorchuk
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.forename: M F
authors.initials: MF
authors.lastname: Rattes
authors.forename: K L
authors.initials: KL
authors.lastname: Chan
mesh_terms: D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D004280:Dobutamine; D004361:Drug Tolerance; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole