[Dobutamine-related coronary spasm among patients with false positive dobutamine stress echocardiography: Prevalence and predictors].
OBJECTIVE
Dobutamine stress echocardiography (DSE) is being consistently used as an exercise-independent stress modality aimed at the detection of coronary artery disease (CAD) and the evaluation of myocardial ischemia. It may though occasionally induce coronary vasospasm. In this study, we aimed to evaluate the prevalence and predictors of dobutamine-related coronary spasm in patients without known CAD and false positive DSE (positive DSE but no significant coronary lesions on angiogram).


METHODS
Three thousand nine hundred and fifty-two patients referred to our echocardiography laboratory for DSE between January 2010 and May 2012 were prospectively investigated. Those with positive DSE underwent coronary angiograms with systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients with spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were enrolled and compared with those with positive DSE but no coronary lesions nor spontaneous or induced spasm ("true" false positive DSE).


RESULTS
Twenty-nine patients with DSE-related vasospasm (19.4% of positive DES without known CAD) were compared with 56 patients with no lesions and no spasm ("true" false positive DSE). They were more frequently smokers (72.4% vs 37.5%; P=0.003); they had more frequently dyslipidemia (79.3% vs 43%; P=0.001); they also had a larger ischemic area at peak DSE (3.4 segments vs 2.7 segments; P=0.05). On multivariate analysis, dyslipidemia (HR=10.7; 95% CI=[2.7-42.1]; P=0.001) and active smoking (HR=6.1; 95% CI=[1.7-21.1]; P=0.004) were found to be independent predictors of spasm-related DSE rather than "true" false positive DSE.


CONCLUSIONS
DSE-related coronary spasm is present in a significant proportion of patients with erroneously labelled "false" positive DSE and should systematically be ruled out. Dyslipidemia and active smoking were independent predictors of spasm rather than "true" false positive DSE.
Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharm écologie cardiovasculaire, Avignon université, 84000 Avignon, France.
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Aboukhoudir
Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France.
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Aboukhoudir
Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France.
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M
Pansieri
Service de cardiologie, centre hospitalier Nord - Franche-Comté, 14, rue de Mulhouse, 90000 Belfort, France. Electronic address: sofienerek@yahoo.fr.
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Rekik
D003324:Coronary Artery Disease / Q000175:diagnosis; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000453:epidemiology*; D004280:Dobutamine / Q000009:adverse effects*; D025401:Echocardiography, Stress; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies
D004280:Dobutamine
Coronary spasm; Dobutamine stress echocardiography; Spasme coronaire; Échocardiographie à la dobutamine