title: Coronary vasospasm as a source of false positive results during dobutamine echocardiography.
abstract: BACKGROUND
  Several studies have demonstrated a consistently high sensitivity of dobutamine echocardiography whereas test specificity in these series has been variable. The aim of this study was to evaluate whether coronary vasospasm--elicited by alpha1 adrenoreceptor stimulation--may be a significant source of false positive responses during dobutamine stress.
  
  
  METHODS
  From the data bank of four institutions we selected 113 patients (75 males, 38 females, mean age 55 +/- 12 years) with dobutamine echocardiography performed (up to 40 micrograms/kg/min and atropine 1 mg if needed) before a coronary angiography showing normal or near normal (visually assessed stenosis severity < 50%) coronary arteries. The following variables--which were previously reported influencing dobutamine echo specificity--entered the multivariate statistical analysis: age, sex, heart rate at baseline and at peak stress, baseline echo, hypertension, site of asynergy, and spasm at coronary angiography.
  
  
  RESULTS
  Twenty-five patients had a positive dobutamine test. The positivity occurred in the left coronary territory in 15 and in the right coronary territory in 10 cases. All the 6 patients with spontaneous spasm during angiography had a false positive stress test result. By multivariate analysis only coronary artery spasm during angiography (p = 0.0015) and history of hypertension (p = 0.0031) were significant predictors of false positive results of dobutamine stress echocardiography.
  
  
  CONCLUSIONS
  Coronary artery spasm may be an important source of false positive results during dobutamine stress echocardiography.
authors.affiliation: Second Department of Medicine, Albert Szent-Györgyi University Medical School, Szeged, Hungary. vargaa@in2nd.szote.u-szeged.hu
authors.forename: A
authors.initials: A
authors.lastname: Varga
authors.forename: L
authors.initials: L
authors.lastname: Cortigiani
authors.forename: P C
authors.initials: PC
authors.lastname: Rossi
authors.forename: E
authors.initials: E
authors.lastname: Cseh
authors.forename: M
authors.initials: M
authors.lastname: De Nes
authors.forename: M G
authors.initials: MG
authors.lastname: Trivieri
authors.forename: M
authors.initials: M
authors.lastname: Csanády
authors.forename: E
authors.initials: E
authors.lastname: Picano
mesh_terms: D003327:Coronary Disease / Q000000981:diagnostic imaging; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D005189:False Positive Reactions; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*
chemical_list: D004280:Dobutamine