Acute Beta Blockade at Peak Stress: Will It Alter the Sensitivity of Dobutamine Stress Echocardiography in Patients with Normal Resting Wall Motion?
BACKGROUND
We compared the accuracy of recovery phase images following administration of intravenous propranolol with peak stress images, for detection of coronary artery disease in patients with no resting wall motion abnormalities undergoing dobutamine stress echocardiography.


METHODS
We enrolled 100 consecutive patients with no resting wall motion abnormalities who underwent dobutamine stress echocardiography. Propranolol was injected after termination of dobutamine infusion. Positive peak stress images were defined as the induction of wall motion abnormalities at any stage before propranolol injection. Positive recovery phase images were defined as maintenance or worsening of wall motion abnormalities induced at peak stress, or the appearance of new wall motion abnormalities during recovery phase. Significant coronary stenosis was defined as ≥ 50% obstruction of ≥ 1 sizable artery by coronary angiography.


RESULTS
Seventy-two patients (72%) had significant coronary artery disease. Analysis of peak stress images revealed sensitivity, specificity, positive and negative predictive values of 80.6%, 85.7%, 93.5%, and 63.2%; the overall accuracy was 82%. Analysis of the recovery phase images revealed sensitivity, specificity, positive and negative predictive values of 91.7%, 75%, 90.4%, and 77.8%; here, the overall accuracy was 87%.


CONCLUSIONS
In patients with no resting wall motion abnormalities, acute beta blockade during dobutamine stress echocardiography improved the sensitivity of recovery phase images for detection of significant coronary artery disease versus peak stress images, but with reduced specificity.


BACKGROUND
Accuracy; Beta blocker; Coronary artery disease; Dobutamine stress echocardiography; Recovery phase images.
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Zainab
Z
Abdel-Salam
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Mohamed
M
Ghazy
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Mohamed
M
Khaled
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Wail
W
Nammas