Limitations of preoperative dobutamine stress echocardiography in identifying severe left main coronary artery stenosis: a report of two cases and a brief review.
OBJECTIVE
Using case illustrations, to elucidate factors which increase the likelihood of false negative preoperative dobutamine stress echocardiography (DSE) studies in patients with severe left main coronary artery stenosis, and to provide criteria which must be met in order to ensure the accurate interpretation of these tests.
Two patients presented for elective abdominal aortic aneurysm repair within a one-month period of time. Both patients had DSE as part of their preoperative assessment, which were interpreted as normal. Nevertheless, both suffered major coronary events in the perioperative period, and both proved to have severe left main coronary artery stenosis on postoperative angiography. A narrative review is presented based on a selection of the current literature, and local experience with the technique. Some pitfalls in the interpretation of these tests are presented, along with modalities to increase their sensitivity and specificity.


CONCLUSIONS
DSE is an important and useful modality in the preoperative cardiac evaluation of patients who are unable to exercise. However the reliable interpretation of the test depends on an understanding of the limitations of the procedure.
Thompson
Calvin
C
Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada.
Bergstrome
Douglas
D
Parlow
Joel L
JL
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D002316:Cardiotonic Agents / Q000008:administration & dosage; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis*; D004280:Dobutamine / Q000008:administration & dosage; D025401:Echocardiography, Stress / Q000379:methods*; D017558:Elective Surgical Procedures; D005188:False Negative Reactions; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011300:Preoperative Care / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D002316:Cardiotonic Agents; D004280:Dobutamine