[A comparison of echocardiography with dobutamine administration and the stress test in detecting coronary disease].
BACKGROUND
Echocardiography with dobutamine has been proposed as a useful tool in the diagnosis and assessment of coronary artery disease.


METHODS
To determine the usefulness of echocardiography combined with dobutamine infusion (10 micrograms/kg/min, with increments of 10 micrograms/kg/min every 3 min up to 40 micrograms/kg/min) and atropine if submaximal heart rate is not achieved in detecting coronary artery disease, 45 patients with chest pain underwent this test, exercise stress test and coronary angiography.


RESULTS
No significant differences were found between double product (peak heart rate x systolic pressure) after dobutamine infusion (18,774) and after exercise (16,950; p = NS). Significant coronary artery disease, defined as having 70% stenosis in, at least, one major vessel, was present in 30 patients. Although overall sensitivity of dobutamine echocardiography test (70%) was similar than that obtained by exercise stress test (66%), sensitivity of the subgroup of patients with single-vessel disease was significantly higher (66 vs 42%, respectively; p < 0.05). Specificity was slightly higher with dobutamine echocardiography test (94%) than with exercise stress test (66%; p = 0.07). Side effects and major complications (hypotension, ventricular tachycardia, heart failure) were present in 8 (18%) and 3 (6%) patients, respectively. ECG during dobutamine administration become positive for ischemia in 17 patients with and 1 without coronary artery disease.


CONCLUSIONS
Dobutamine echocardiography test is highly sensitive and specific for the detection of coronary artery disease. Its sensitivity in patients with single-vessel disease is better than that obtained by exercise stress test. Complications after dobutamine infusion must be kept in mind.
San Román
J A
JA
Departamento de Ecocardiografía, Hospital Universitario de San Carlos, Madrid.
Vilacosta
I
I
Castillo
J A
JA
Rollán
M J
MJ
Sánchez-Harguindey
L
L
D000368:Aged; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005080:Exercise Test / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
D004280:Dobutamine
Comparación de la ecocardiografía con administración de dobutamina y la prueba de esfuerzo en la detección de enfermedad coronaria.