REGIONAL WALL-MOTION CHANGES WITH DOBUTAMINE AS A PHARMACOLOGICAL STRESS TEST DURING CARDIAC-CATHETERIZATION IN PATIENTS WITH SIGNIFICANT CORONARY-ARTERY DISEASE

Background: Preliminary study to test the feasibility of pharmacologic al stress testing during cardiac catheterization, thus combining anato mical and functional information. Patients and methods: 21 consecutive patients with known or suspected coronary artery disease, referred fo r diagnostic catheterization, Biplane ventriculography was performed b efore and during dobutamine infusion. The patients were subdivided int o 3 groups: Group I (n = 11, 52%) with at least one territory supplied by a significantly stenosed coronary artery and showing normal restin g regional wall motion. Group II (n = 6, 29%) patients in whom the aff ected vessel(s) supplied exclusively a territory with regional wall mo tion abnormalities at rest. Group III (n = 4, 19%) had no significant coronary artery disease and served as control. Results: In group I, 9/ 11 (82%) patients and in group II, 3/6 (50%) patients showed either is chemia Or viability reactions or both after dobutamine stress. Overall , substantial functional information was gathered in 12/17 patients (7 1%). Control patients showed no worsening of regional wall motion unde r dobutamine. Neither global left ventricular ejection fraction nor le ft ventricular end diastolic pressure were as accurate in detecting is chemia as regional wall motion analysis. In patients who had only isch emia and no viability reaction as judged by regional wall motion analy sis, ejection fraction fell significantly in 4/6 (67%) patients; end d iastolic pressure on the other hand rose significantly in 3/6 (50%). C onclusions: Dobutamine stress testing performed during cardiac cathete rization is convenient, feasible and safe and yields clinically useful information in a high percentage (71%) of patients with significant c oronary artery disease. Further experience is needed to evaluate the s ensitivity, specificity and predictive value of this new approach.