title: Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography.
abstract: Large numbers of patients referred for evaluation of chest pain are unable to perform adequate, diagnostic exercise testing. In these patients, dobutamine stress echocardiography (DSE) represents an alternative, exercise-independent stress modality. Apart from the approximately 5% of patients with an inadequate acoustic window, 10% of patients referred for this test have nondiagnostic (submaximal negative) test results. Serious side effects during or shortly after DSE are uncommon, with ventricular fibrillation or myocardial infarction occurring in approximately 1 of 2,000 studies. No deaths have been reported. On the basis of a total number of 2,246 patients, reported in 28 studies, the sensitivity, specificity and accuracy of the test for the detection of coronary artery disease (CAD) were 80%, 84% and 81%, respectively. Mean sensitivities for one-, two- and three-vessel disease were 74%, 86% and 92%, respectively. The sensitivity for detection of disease in the left circumflex coronary artery (55%) was lower, both compared with that for left anterior descending (72%) and right coronary artery disease (76%). The sensitivity of predicting multivessel disease by multiregion echocardiographic abnormalities varied widely, from 8% to 71%. In direct comparisons, DSE was superior to exercise electrocardiography and dipyridamole echocardiography and comparable to exercise echocardiography and radionuclide imaging. DSE is a useful, feasible and safe exercise-independent stress modality for assessing the presence, localization and extent of CAD.
authors.affiliation: Thoraxcentre, University Hospital Rotterdam-Dieczigt, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Geleijnse
authors.forename: P M
authors.initials: PM
authors.lastname: Fioretti
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
mesh_terms: D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D015588:Observer Variation; D012680:Sensitivity and Specificity
chemical_list: D004280:Dobutamine