[Evaluation of a new stress echocardiography technique combining exercise and dobutamine in the detection of coronary disease].
Dobutamine stress echocardiography (DSE) and exercise stress echocardiography (ESE) are widely used for diagnosis of coronary artery disease. Each of these methods has limitations: secondary effects of Dobutamine, poor imaging quality, difficulty in attaining the maximal heart rate. The authors evaluated a test associating pedalling exercise at a constant low load (30-60 watts) with Dobutamine infusion (10-20-30-40 j/Kg/min +/- Atropine) (DES + E) in 42 patients referred for suspected coronary artery disease. All patients underwent coronary angiography on Day 1. There was significant coronary disease (> 50% stenosis) in 19 of the 42 patients. Sensitivity, specificity, negative predictive value, positive predictive value and overall diagnosis value were respectively 84, 87, 84, 87 and 86%. In the first 20 patients, the DES + E was compared directly with DES: There was only one undesirable side effect (hypertension) with DES + E compared with 5 with DES alone. The target heart rate was attained with lower doses of Dobutamine with DES + E (32.35 vs 39.42 j/Kg/min, p = 0.05). DES + E therefore seems to be a promising technique which is better tolerated than DES alone with very satisfactory diagnostic performances. However, these results require further confirmation in larger numbers of patients.
Pierre-Justin
E
E
Service de cardiologie, 8 étage, hôpital Gabriel-Montpied, rue Montalemberg, BP 69, 63003 Clermont-Ferrand.
Marcollet
P
P
Lusson
J R
JR
Motreff
P
P
Dauphin
C
C
Lamaison
D
D
Cassagnes
J
J
D002316:Cardiotonic Agents; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012680:Sensitivity and Specificity
D002316:Cardiotonic Agents; D004280:Dobutamine