title: Mechanisms of regional wall motion abnormalities in contrast-enhanced dobutamine stress echocardiography.
abstract: BACKGROUND
  In the diagnosis of coronary artery disease (CAD) with Dobutamine Stress Echocardiography (DSE), regional wall motion abnormalities (RWMA) are assumed to indicate a perfusion deficit.
  
  
  RESULTS
  For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone)-enhanced DSE (0-40 microg/kg Dobutamine, 16-segment- model) and MiBi-SPECT in a prospective double-blinded study design in 69 non-selected consecutive patients (44 male, 25 female, age 64+/-12 years). Additionally, all patients were examined by coronary-angiography. The prevalence of significant CAD (stenosis >50% lumen diameter) was 52%. DSE had a sensitivity of 78% and a specificity of 66% for the detection of significant CAD with a positive and negative predictive value of 72 and 73%, respectively. Among 28 patients with significant CAD and positive DSE study (true positive), 78% displayed a corresponding perfusion deficit in MiBi-SPECT. Among 11 patients with a positive DSE study but no current significant coronary stenosis (false positive), 82% showed stress-induced RWMAs in the inferior/posterior region, 73% displayed left ventricular hypertrophy, 54% resting-ECG abnormalities and 45% resting-RWMA (3 previous MI, 2 previous CABG surgery). Among 8 patients with negative DSE study but significant coronary stenosis (false negative), 75% had a stenosis of the LCX, 63% displayed resting- WMA, 63% displayed left bundle branch block or ST-segment depression, 50% displayed only peripheral coronary stenosis, and DSE visualization was suboptimal in 38%.
  
  
  CONCLUSIONS
  This prospective study in non-selected patients shows that the majority of RWMAs in DSE are matched to a perfusion deficit detectable by nuclear imaging. Nevertheless, pre-existing cardiac abnormalities may also lead to stress-induced RWMA not associated with a perfusion deficit or mask a perfusion deficit upon DSE. Particularly in patients with LV hypertrophy, resting-RWMA, bundle branch block or ST segment depression, the predictive value of DSE may, therefore, be limited.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, University of Regensburg, 93042, Regensburg, Germany. norbert.heinicke@klinik.uni-regensburg.de
authors.forename: N
authors.initials: N
authors.lastname: Heinicke
authors.forename: B
authors.initials: B
authors.lastname: Benesch
authors.forename: T
authors.initials: T
authors.lastname: Kaiser
authors.forename: K
authors.initials: K
authors.lastname: Debl
authors.forename: M
authors.initials: M
authors.lastname: Segmüller
authors.forename: J
authors.initials: J
authors.lastname: Schönberger
authors.forename: J
authors.initials: J
authors.lastname: Marienhagen
authors.forename: C
authors.initials: C
authors.lastname: Eilles
authors.forename: G A J
authors.initials: GA
authors.lastname: Riegger
authors.forename: S
authors.initials: S
authors.lastname: Holmer
authors.forename: A
authors.initials: A
authors.lastname: Luchner
mesh_terms: D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004280:Dobutamine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002316:Cardiotonic Agents; D019275:Radiopharmaceuticals; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi