title: Head-to-head comparison of dobutamine and adenosine stress real-time myocardial perfusion echocardiography for the detection of coronary artery disease.
abstract: We sought to determine the value of dobutamine versus adenosine real-time myocardial perfusion (MP) echocardiography for detecting coronary artery disease and the value of quantitative analysis of MP over electrocardiography, wall motion, and qualitative MP. We studied 54 patients by real-time MP echocardiography and coronary angiography. Replenishment velocity (beta) and an index of myocardial blood flow (A(n)xbeta) were derived from quantitative MP. During dobutamine stress, beta (1.7 +/- 0.7 vs 2.7 +/- 1.2; P < .001) and A(n)xbeta (2.2 +/- 1.0 vs 3.5 +/- 1.6; P < .001) reserves were lower in patients with coronary artery disease. The same was observed with adenosine for beta (1.7 +/- 0.8 vs 2.5 +/- 1.1; P < .001) and A(n)xbeta (1.9 +/- 0.7 vs 3.2 +/- 1.4; P < .001) reserves. Accuracy of electrocardiography, wall motion, qualitative MP, and quantitative MP were 61%, 76%, 76%, and 80% for dobutamine and 70%, 70%, 76%, and 80% for adenosine, respectively. Quantitative MP had incremental diagnostic value over other variables during dobutamine (chi(2) 23.7-38.4; P < .001) and adenosine (chi(2) 26.7-59.4; P < .001). In conclusion, dobutamine and adenosine real-time MP echocardiography hold similar accuracy for detecting coronary artery disease. Quantitative MP provides incremental diagnostic information over other variables.
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kowatsch
authors.forename: Jeane M
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: Altamiro F F
authors.initials: AF
authors.lastname: Osório
authors.forename: Augusto H
authors.initials: AH
authors.lastname: Uchida
authors.forename: Gilberto G A
authors.initials: GG
authors.lastname: Machiori
authors.forename: Marden L
authors.initials: ML
authors.lastname: Lopes
authors.forename: Luiz A M
authors.initials: LA
authors.lastname: César
authors.forename: José Antônio F
authors.initials: JA
authors.lastname: Ramires
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D000241:Adenosine