title: Enhanced sensitivity of dobutamine stress echocardiography by observing wall motion abnormalities during the recovery phase after acute beta-blocker administration.
abstract: Dobutamine stress echocardiography (DSE) has a modest sensitivity for detecting single-vessel coronary artery disease (CAD). This study assessed the additional diagnostic value of new or worsening wall motion abnormalities during recovery after acute administration of beta blockers. The study population consisted of 200 patients (mean 59 +/- 11 years of age, 144 men), who underwent DSE. Images were acquired at rest, low dose, peak dose, and during recovery. Patients received intravenous metoprolol (1 to 5 mg/min). The dose was adjusted to achieve a recovery heart rate within a 10% range of heart rate at rest. Coronary angiography was performed within 2 months. Inducible new wall motion abnormalities were observed in 168 patients (84%) at peak stress. An additional 14 patients (7%) developed new or worsening wall motion abnormalities during recovery. CAD was detected in 182 patients (86 had single-vessel CAD). Sensitivity, specificity, and accuracy of DSE were 88%, 65%, and 73% at peak stress and 97%, 65%, and 74% during recovery. Sensitivity was particularly higher during recovery than during peak stress in patients with single-vessel CAD (98% vs 81%, p <0.001). In conclusion, assessment of wall motion abnormalities during the recovery phase after acute beta blockade improves sensitivity of DSE, particularly in patients with single-vessel CAD.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Stefanos E
authors.initials: SE
authors.lastname: Karagiannis
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Herman H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Dennis V
authors.initials: DV
authors.lastname: Cokkinos
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Maarten
authors.initials: M
authors.lastname: Simoons
authors.forename: Daniel
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000503:physiopathology*; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D000319:Adrenergic beta-Antagonists; D004280:Dobutamine; D008790:Metoprolol