title: [Coronary artery spasm during dobutamine stress echocardiography: prevalence, clinical and echocardiographic characteristics and prognosis].
abstract: OBJECTIVE
  To assess the prevalence of coronary artery spasm during dobutamine stress chocardiography (DSE), to describe clinical and echocardiographic characteristics and prognosis.
  
  
  METHODS
  We evaluated all the patients with known or suspected coronary artery disease (CAD) referred to our echocardiography laboratory for dobutamine stress test between January 2004 and June 2012, (10013 exams). Those with abnormal DSE underwent coronary angiograms with a systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were included.
  
  
  RESULTS
  One thousand and four patients had abnormal DSE, 78 (7.7%) fulfilled the inclusion criteria. There were 57 males and 21 females, mean age was 57.9 years, 37 patients had a known history of CAD. Twenty-four patients had a spasm on the left anterior artery (31%), 37 on the right coronary artery (47%) and 17 on the circumflex (22%). There was a good correlation between spastic arteries and dobutamine induced wall motion abnormalities territories. No complications occurred during the exams or during the provocation test. After 46 months mean follow up; one case of myocardial infarction with normal coronary arteries was noted and six patients experienced recurrent angina responding to treatment intensification.
  
  
  CONCLUSIONS
  Coronary artery spasm during DSE but is a rare and under-diagnosed finding; it has, though, to be recognized as it may partly explain some erroneously labelled "false positive" exams. Methylergometrine provocation test should be performed in such a situation to establish the diagnosis. Prognosis appears favourable.
authors.affiliation: Centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France.
authors.forename: F
authors.initials: F
authors.lastname: Aboukhoudir
authors.forename: S
authors.initials: S
authors.lastname: Rekik
authors.forename: S
authors.initials: S
authors.lastname: Andrieu
authors.forename: S
authors.initials: S
authors.lastname: Cheggour
authors.forename: M
authors.initials: M
authors.lastname: Metge
authors.forename: J-L
authors.initials: JL
authors.lastname: Hirsch
authors.forename: P
authors.initials: P
authors.lastname: Barnay
authors.forename: J-P
authors.initials: JP
authors.lastname: Faugier
authors.forename: S
authors.initials: S
authors.lastname: Gonzalez
authors.forename: I
authors.initials: I
authors.lastname: Aboukhoudir
authors.forename: C
authors.initials: C
authors.lastname: Gonthier
authors.forename: Y
authors.initials: Y
authors.lastname: Klioua
authors.forename: M
authors.initials: M
authors.lastname: Pansieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000453:epidemiology*; D004280:Dobutamine / Q000009:adverse effects*; D025401:Echocardiography, Stress / Q000009:adverse effects*; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008755:Methylergonovine; D008875:Middle Aged; D010120:Oxytocics; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D002316:Cardiotonic Agents; D010120:Oxytocics; D004280:Dobutamine; D008755:Methylergonovine