title: Comparison of the diagnostic potential of four echocardiographic stress tests shortly after acute myocardial infarction: submaximal exercise, transesophageal atrial pacing, dipyridamole, and dobutamine-atropine.
abstract: This study assessed and compared the diagnostic potential of submaximal exercise, transesophageal atrial pacing, dipyridamole, and dobutamine-atropine stress echocardiography tests shortly after acute myocardial infarction. In 121 study patients, 325 digital echocardiographic stress tests were attempted 10 to 11 days after acute myocardial infarction: 83 submaximal exercise tests, 121 high-dose dipyridamole echocardiography tests (DET), 69 transesophageal atrial pacing tests (< 150 beats/min), and 52 dobutamine tests, starting at 10 microgram/kg per minute, increasing stepwise to 40 microgram kg/min, and coadministering atropine in 12 patients (dobutamine-atropine stress echocardiography [DASE]). Results were correlated to a coronary artery diameter stenosis > or = 50% as determined by quantitative angiography. Feasibility to perform submaximal exercise echocardiography, atrial pacing echocardiography, DET, and DASE was 89%, 52%, 98%, and 88%, respectively. Atrial pacing was not tolerated by 18 patients and refused by 6 (9%). Severe but not life-threatening side effects were hypotension in DET (2%) and tachyarrhythmias in DASE (6%). Test positivity in multivessel disease with submaximal exercise, DET, and DASE was 55%, 93%, and 90%, respectively, and in 1-vessel disease 47%, 65%, 71%, and for atrial pacing, 82%, respectively. We conclude that submaximal exercise has limited sensitivity and atrial pacing limited feasibility. The pharmacologic stressors provide a useful, safe diagnostic approach: DET with slightly lower sensitivity in 1-vessel disease and DASE with insignificantly less feasibility.
authors.affiliation: Department of Cardiology, Klinikum Benjamin Franklin, Free University of Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schröder
authors.forename: H
authors.initials: H
authors.lastname: Völler
authors.forename: H
authors.initials: H
authors.lastname: Dingerkus
authors.forename: H
authors.initials: H
authors.lastname: Münzberg
authors.forename: R
authors.initials: R
authors.lastname: Dissmann
authors.forename: T
authors.initials: T
authors.lastname: Linderer
authors.forename: H P
authors.initials: HP
authors.lastname: Schultheiss
mesh_terms: D001285:Atropine; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods; D002316:Cardiotonic Agents; D003251:Constriction, Pathologic; D004176:Dipyridamole / Q000009:adverse effects; D004280:Dobutamine / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole; D001285:Atropine