[The predictive signs of multivessel coronary disease in echocardiography with dobutamine].
OBJECTIVE
To assess the ability of dobutamine echocardiography to detect multivessel coronary artery disease and to determine predictive factors for multivessel disease with or without beta-blockers.


METHODS
A total of 101 patients underwent dobutamine stress echocardiography and coronary angiography (evaluation of chest pain 76, extent of coronary disease after myocardial infarction 19, other indications 6).


RESULTS
Ten patients in whom the test was prematurely terminated were excluded. Out of 91 patients who underwent dobutamine echocardiography, 54 patients had multivessel disease (sensitivity of dobutamine test 93%, specificity 46%). Heart rate at the maximum dose of dobutamine or atropine was 88 +/- 21 beats/min for multivessel diseases and 104 +/- 21 beats/min without multivessel disease (p < 0.001). A cut-off value < 94 beats/min discriminated patients at risk for multivessel disease. After adjusting for treatment with beta-blockers, heart rate < 94 beats/min, ECG signs of ischemia, and abnormalities on baseline echocardiogram with remote asynergies during dobutamine testing were independent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present).


CONCLUSIONS
A heart rate < 94 beats/min at peak dose of dobutamine or after atropine, ECG signs of ischemia, and the presence of abnormalities on echocardiogram at rest with remote asynergies during dobutamine stress testing were independent predictive factors of multivessel coronary artery disease.
Cladellas
M
M
Servicio de Cardiología, Hospital Universitario del Mar, Universidad Autónoma de Barcelona.
Bruguera
J
J
Grau
S
S
Hernández
J
J
Illa
J
J
Sardà
R
R
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000008:administration & dosage; 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; D011379:Prognosis; D012680:Sensitivity and Specificity
D002316:Cardiotonic Agents; D004280:Dobutamine