Dipyridamole-dobutamine stress echocardiography for the detection of myocardial ischemia in patients with hypertension.
OBJECTIVE
To assess the value of dipyridamole-dobutamine stress echocardiography test (Dip-Dob SET) in detecting myocardial ischemia in hypertensive patients with chest pain and to compare it with the results of the dipyridamole-atropine stress echocardiography test (Dip-Atro SET).


METHODS
127 consecutive hypertensives with chest pain (82 male, mean age 54.5+/-7.9 years) and nondiagnostic exercise stress test were evaluated. Patients were randomly assigned to receive dobutamine 5-40 microg/kg/min (Dip-Dob group, 55 patients) or atropine 0.25 mg in four divided doses up to 1 mg (Dip-Atro group, 72 patients), if high Dip SET was negative (Dip up to 0.84 mg/kg over 10 min). 84 patients underwent coronary angiography (42 in the Dip-Atro and 42 in the Dip-Dob group).


RESULTS
76 tests were positive for new dyssynergy (16 segment/4-grade model of wall motion analysis), 39 in the Dip-Atro and 37 in the Dip-Dob group, 42 were negative, and nine were stopped due to non-life-threatening side effects, four in the Dip-Atro and five in the Dip-Dob group. Delta wall motion score index (WMSI) was significantly higher in the Dip-Dob than the Dip-Atro group (0.34+/-0.3 vs. 0.21+/-0.4; p<0.01). Coronary artery disease (>or= 50% diameter stenosis) was found in 56/84 patients, 30 patients had multivessel disease (14 in the Dip-Atro and 16 in the Dip-Dob group; p>0.05). Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value were 92.9%, 78.6%, 88.1%, 89.7%, and 84.6% versus 89.3%, 92.9%, 90.5%, 96.2%, and 81.2% (p>0.05, Dip-Dob vs. Dip-Atro).


CONCLUSIONS
There was no significant difference in feasibility, safety and diagnostic accuracy between the Dip-Dob and Dip-Atro test. The Dip-Dob test showed more pronounced ability to provoke myocardial ischemia than the Dip-Atro test, expressed as a higher delta WMSI. Both tests confirmed high diagnostic accuracy of pharmacological stress echocardiography in hypertensive patients.
Milosavljevic
Jelica
J
Department of Cardiology, Medical Center, Jagodina, Serbia and Montenegro.
Ostojic
Miodrag
M
Marinkovic
Jelena
J
D004176:Dipyridamole; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole