DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN THE DETECTION OF CORONARY-ARTERY DISEASE IN A CLINICAL-PRACTICE SETTING

In this prospective study, patients referred for coronary angiography for detection of disease underwent dobutamine stress echocardiography to define its value in a clinical practice setting. Results: Of 219 pa tients studied, 170 (78%) had significant coronary artery disease. The overall sensitivity and specificity of dobutamine stress echocardiogr aphy for coronary artery disease were 82 and 65%, respectively. The se nsitivity was 88% for detection of triple-vessel disease, 83% for doub le-vessel disease, and 74% for single-vessel disease. Positive and neg ative predictive values for coronary artery disease were 89 and 51%, r espectively. Dobutamine stress echocardiography correctly identified o nly 72 of 138 patients with significant stenosis of the left anterior descending coronary artery. In 219 patients, 345 of 657 major epicardi al vessels had significant disease. Dobutamine stress echocardiography could only correctly identify the vessel involved in 188. Triple-vess el disease was present in 65 patients. Dobutamine stress echocardiogra phy correctly categorised 18% (n=12) of these. The remainder were inco rrectly classified as having double-vessel disease or single vessel di sease (n=45), or no disease at all (n=8). Conclusion: Dobutamine stres s echocardiography performs well. However, lower specificity may lead a to unwarranted referrals for coronary angiography, and the low NPV g ive false reassurance as to the absence of disease. (C) 1997 Elsevier Science Ireland Ltd.