Pneumatic lower extremity compression during dobutamine stress echocardiography

Background Afterload is expected to increase with pneumatic compression of the lower extremities. There are left ventricular (LV) wall stress, which is the most important factor determining myocardial oxygen demand, will also increase, leading to an increase in the sensitivity of dobutamine stress echocardiography (DSE) or a shortened time to a positive response. Methods and Results In 40 patients who underwent DSE and were anticipating undergoing coronary angiography (CAG), the imaging was repeated with pneumatic compression (100mmHg) of the lower extremities (DSEcomp) prior to CAG. The sensitivity and specificity of DSE and DSEcomp were determined based on the CAG findings. All patients tolerated pneumatic compression of the lower extremities during the tests. LV end-systolic volume (p=0.042) and end-systolic wall stress (p=0.036) were significantly greater with DSEcomp than with DSE. In 3 patients with false-negative results for DSE, DSEcomp gave a positive response, demonstrating a significant increase in sensitivity from 75% to 94% (p=0.045). Only 1 patient with a true negative result for DSE was interpreted as showing a positive response for DSEcomp, resulting in a decrease in specificity from 88% to 83% (p=NS). In 10 of 12 patients with true positive results for both DSE and DSEcomp, positive responses were seen at least 1 stage earlier with DSEcomp than with DSE. Conclusions Pneumatic compression of the lower extremities increases the sensitivity of DSE and shortens the time to a positive response.