title: [Stress echocardiography with dobutamine in the identification of coronary disease in patients with left bundle branch block].
abstract: Left bundle branch block does not permit an easy diagnosis of coronary heart disease (CAD) with provocative non-invasive test such as bicycle or treadmill stress test. Echocardiography allows the identification of segmental wall motion by evaluating the movement as well the thickness of the segment examined. Due to its agonist action on beta 1 receptors, dobutamine causes an increase in myocardial oxygen consumption and, as a consequence, may reveal myocardial ischemia; on this basis, we evaluated the sensibility, specificity and diagnostic accuracy of dobutamine stress-echo in identifying CAD in patients with left bundle branch block, and compared results with those obtained from coronary catheterization. From February 1994 to September 1995 we observed 25 patients with left bundle branch block (17 men, 8 women, mean age 61.8 +/- 8.4 years, range 43.75), affected or suspected for CAD. All patients underwent dobutamine stress-echo test and coronary arteriography. We divided patients into two groups: the first one (11 patients) with acute myocardial infarction, the second one (14 patients) without previous ischemic episodes. Diagnostic accuracy, specificity and sensibility of the stress-echo test were evaluated in order to identify significant stenosis of the left anterior descending (LAD), right coronary (RCA), and/or circumflex artery (CA). Dobutamine stress echocardiography showed in all patients, from basal to peak, an increase in blood pressure (from 121.2 +/- 17.4 to 141.8 +/- 23.6 mmHg), heart rate (from 81.3 +/- 10.9 to 140.7 +/- 8.9 b/min), and double product (from 9861.1 +/- 1898.1 to 19976.6 +/- 3603.6). In 8 (32%) patients who had typical chest pain, 7 had CAD. In 17 (68%) patients without chest pain, 5 had CAD and 12 had normal coronary arteries. Dobutamine stress echocardiography showed segmental wall motion variations only in 13 patients; 12 of them had a significant stenosis of coronary artery relative to the ischemic area, the other 1 was a false positive. Coronary arteriography showed stenosis of LAD in 10 and of RCA and/or CA in 12 patients, in both groups dobutamine stress-echo test had 1 false negative. Dobutamine stress echocardiography showed high diagnostic value as a provocative non-invasive test for CAD in patients with left bundle branch block. In conclusion, or study shows that no statistical difference exists in identifying ischemia in identifying ischemia in the LAD territory compared to RCA and/or CA. Further investigations are need to confirm the higher diagnostic accuracy in patients with left bundle branch block and to establish whether lower specificity in patients with a previous myocardial infarction is due to the smaller number of patients or to methodology.
authors.affiliation: Istituto di Cardiologia, Università degli Studi, Catania.
authors.forename: S
authors.initials: S
authors.lastname: Scandura
authors.forename: S
authors.initials: S
authors.lastname: Felis
authors.forename: G
authors.initials: G
authors.lastname: Barbagallo
authors.forename: W
authors.initials: W
authors.lastname: Deste
authors.forename: A
authors.initials: A
authors.lastname: Drago
authors.forename: P
authors.initials: P
authors.lastname: D'Aleo
authors.forename: V
authors.initials: V
authors.lastname: Calvi
authors.forename: G
authors.initials: G
authors.lastname: Giuffrida
mesh_terms: D000318:Adrenergic beta-Agonists; D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000503:physiopathology*; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004280:Dobutamine; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013312:Stress, Physiological / Q000503:physiopathology; D014463:Ultrasonography
chemical_list: D000318:Adrenergic beta-Agonists; D004280:Dobutamine