DOBUTAMINE STRESS ECHOCARDIOGRAPHY - ITS ROLE IN THE DIAGNOSIS OF CORONARY-ARTERY DISEASE

We have assessed the usefulness of dobutamine infusion for the diagnosis of coronary artery disease by using two-dimensional echocardiography and 12-lead electrocardiogram. Dobutamine was infused at incremental doses (up to a maximum of40 μg kg-1min-1) in 52 patients with chest pain; all the patients underwent coronary angiography; significant coronary artery disease was quantitatively defined as ≥ 50% diameter stenosis. Thirty-six patients were on betablockers. The test was considered positive when new regional wall motion abnormalities appeared during dobutamine infusion. No significant side effects occurred in any patient during the test. Transient wall motion abnormalities were detected in 20 of 37 patients with coronary artery disease (sensitivity = 54%); ischaemic ST segment changes were present on ECG in nine patients (sensitivity = 24%). Dobutamine stress echocardiography was negative in 12 of 15 patients with coronary artery diameter stenosis <50% (specficity=80%). Exercise electrocardiography (ECG) was performed in 35 of these 52 patients. Maximum heart rate and systolic blood pressure were signficantly higher during exercise than during dobutamine stress test (127±23 vs 99 ± 24 beats min-1, P<0.0001; 179±25 vs 152±30 mmHg, P <0.0001). The exercise ECG test was positive in 12 of the 26 patients with significant coronary artery disease (sensitivity = 46%), and dobutamine stress echocardiography in 16 (sensitivity = 62=). Dobutamine stress echocardiography test is a safe and feasible diagnostic test for the noninvasive diagnosis of coronary artery disease and can be performed in patients unable to exercise. It provides similar diagnostic accuracy compared to routine exercise testing, adding information on the location and extent of myocardial ischaemia. © 1992 The European Society of Cardiology.