DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN THE DETECTION OF CORONARY-ARTERY DISEASE - IMPORTANCE OF THE PRETEST LIKELIHOOD OF DISEASE

Although the accuracy of dobutamine stress echocardiography For the de tection of coronary artery disease in a high-risk population is known, it has not been well defined for lower risk groups. Two probability g roups, high (>75%; n = 199) and intermediate (>10% but less than or eq ual to 75%; n = 118), were studied. Dobutamine stress echocardiography was performed in a standard fashion. Significant coronary artery dise ase was defined as a >50% luminal diameter stenosis on coronary angiog raphy. The positive predictive accuracy of dobutamine stress echocardi ography for the detection of coronary artery disease was greater in th e high-probability group (96% vs 86%), as was the sensitivity (89% vs 78%), whereas the negative predictive value was greater in the interme diate-probability group (50% vs 23%), as was the specificity (63% vs 5 0%). Dobutamine stress echocardiography does have a diagnostic role in the evaluation of patients with an intermediate probability of corona ry artery disease.