PREDICTORS OF MULTIVESSEL CORONARY-ARTERY DISEASE IN DOBUTAMINE STRESS ECHOCARDIOGRAPHY

Aims. To assess the ability of dobutamine echocardiography to detect m ultivessel coronary artery disease and to determine predictive factors for multivessel disease with or without beta-blockers. Patients and m ethods. A total of 101 patients underwent dobutamine stress echocardio graphy and coronary angiography (evaluation of chest pain 76, extent o f coronary disease after myocardial infarction 19, other indications 6 ). Results. Ten patients in whom the test was prematurely terminated w ere excluded. Out of 91 patients who underwent dobutamine echocardiogr aphy, 54 patients had multivessel disease (sensitivity of dobutamine t est 93%, specificity 46%). Heart rate at the maximum dose of dobutamin e or atropine was 88 +/- 21 beats/min for multivessel diseases and 104 +/- 21 beats/min without multivessel disease (p < 0.001). A cut-off v alue < 94 beats/min discriminated patients at risk for multivessel dis ease. After adjusting for treatment with beta-blockers, heart rate < 9 4 beats/min, ECG signs of ischemia, and abnormalities on baseline echo cardiogram with remote asynergies during dobutamine testing were indep endent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present). Conclusion . A heart rate < 94 beats/min at peak dose of dobutamine or after atro pine, ECG signs of ischemia, and the presence of abnormalities on echo cardiogram at rest with remote asynergies during dobutamine stress tes ting were independent predictive factors of multivessel coronary arter y disease.