Transthoracic coronary flow velocity reserve assessment: comparison between adenosine and dobutamine.
OBJECTIVE
We sought to compare coronary flow velocity reserve (CFVR) with adenosine and dobutamine in patients scheduled for noninvasive evaluation of coronary artery disease.


BACKGROUND
Assessment of CFVR in the distal part of the left anterior descending coronary artery (LAD) by Doppler transthoracic echocardiography (TTE) is usually performed with adenosine in various settings. CFVR can also be determined during dobutamine stress echocardiography (DSE), but it has not been established whether TTE CFVR with dobutamine is equivalent to CFVR with adenosine.


METHODS
In all, 47 consecutive stable patients in sinus rhythm (28 men, 64 +/- 12 years, left ventricular ejection fraction 55 +/- 5%) were prospectively studied. Coronary flow velocity was measured in the distal part of the LAD by TTE, at rest and during continuous infusion of 0.14 mg/kg/min of adenosine over 2 minutes, and during DSE performed immediately after the adenosine test, using a multifrequency transducer, on a modified parasternal view. CFVR with adenosine was calculated as hyperemic to basal peak flow velocity. CFVR with DSE was obtained by calculating peak diastolic flow velocity divided by baseline diastolic flow velocity.


RESULTS
Adequate recording of CFVR with adenosine and dobutamine was possible in 43 (91%) and 41 (87%) patients, respectively. CFVR was 2.5 +/- 0.7 with adenosine compared with 2.4 +/- 0.7 with dobutamine (P = .7). A good linear correlation was observed between the two tests (r = 0.81, P < .0001). In patients with dobutamine-induced wall-motion abnormalities in the LAD territory (n = 8), CFVR was similar during dobutamine and adenosine infusion (1.6 +/- 0.3 vs 1.5 +/- 0.2, respectively, P = .7). Coronary angiography was available in 12 patients (LAD stenosis: 55 +/- 10% quantitative coronary angiography, with a range from 40%-75%). The correlation between CFVR values was also good in this subgroup of patients (r = 0.87, P < .0001).


CONCLUSIONS
TTE CFVR with dobutamine is comparable to CFVR with adenosine in patients with a wide range of LAD diseases. Dobutamine could be a good alternative to adenosine for TTE CFVR assessment, particularly in patients with a contraindication to adenosine or scheduled for DSE.
Meimoun
Patrick
P
Department of Cardiology and Intensive Care Unit, Compiègne Hospital, Compiègne, France. patrickmeimoun@free.fr
Sayah
Smain
S
Tcheuffa
Jean Christophe
JC
Benali
Tahar
T
Luycx-Bore
Anne
A
Levy
Franck
F
Tribouilloy
Christophe
C
D000241:Adenosine / Q000008:administration & dosage; D001783:Blood Flow Velocity; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000187:drug effects; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014665:Vasodilator Agents / Q000008:administration & dosage
D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D000241:Adenosine