Silent coronaropathy: usefulness of dobutamine stress echocardiography in ischemic stroke.
BACKGROUND
Several testing options are available to detect asymptomatic coronary artery disease (CAD). Dobutamine stress echocardiography (DSE) has been reported to increase the sensitivity and specificity of stress testing to detect CAD. Most studies concerned patients with known or suspected CAD who have a high pretest probability of disease. We aimed to perform a preliminary evaluation of DSE in atherothrombotic stroke.


METHODS
Patients with transient ischemic attack or nondisabling ischemic stroke attributable to an atherothrombotic source were prospectively recruited. Patients with a history of angina pectoris or electrocardiographic signs of previous myocardial infarction were excluded. DSE was considered positive when regional reduction or deterioration of myocardial thickening developed in 1 segment. Coronary angiography was performed in patients with positive DSE.


RESULTS
Sixty-four patients were recruited. Analysis of DSE was possible in 60 patients. Overall the test provided clinically useful information in 60/64 patients studied (>90%). DSE was positive in 9 patients (15%). Coronary angiography was performed in 8 patients, high-grade focal lesions were found in 3 patients, and 5 patients showed diffuse atheroma. Univariate logistic regression analysis showed that the main factor predictive of a positive DSE was the presence of an aortic arch atheroma (p = 0.003). Multivariate logistic regression analysis showed that two factors had an independent predictive value of positive DSE: aortic arch atheroma (p = 0.007) and dyslipidemia (p = 0.09).


CONCLUSIONS
DSE may improve prevention of further vascular events in patients with an atherothrombotic source of ischemic stroke. This screening may be of particular benefit to patients with an aortic arch atheroma.
Nighoghossian
Norbert
N
Cerebrovascular Unit, Hospital Pierre Wertheimer, Lyon, France. norbert.nighoghossian@chu-lyon.fr
Cakmak
Serkan
S
Derex
Laurent
L
Barthelet
Martine
M
Thibault
Hélène
H
Finet
Gérard
G
Ovize
Michel
M
Derumeaux
Geneviève
G
Nemoz
Chantal
C
Chapuis
François
F
Rioufol
Gilles
G
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology