A PROSPECTIVE-STUDY OF SYMPTOMS DURING DO BUTAMINE STRESS ECHOCARDIOGRAPHY - IMPLICATIONS ON DIAGNOSTIC-ACCURACY

We used a standardized questionnaire to assess physical and mental dis tress caused by dobutamine stress echocardiography (DSE). The examinat ion was performed according to a standardized protocol (5-40 mu g/kg/m in including atropine). 91 patients (pts), 68 men (62 +/- 9 years), 23 women (65 +/- 7 years) were asked to quantify the severity of the fol lowing symptoms: palpitations, anxiety, headache, nausea, discomfort o f left lateral position, angina pectoris and dyspnea. Numbers on a rat ing scale from 1-10 defined the degree of distress. Absence of a sympt om equalled mark 1, slight expression marks 2-4. Moderate expression w as defined by marks 5-7 and very strong expression by marks 8-10. Resu lts: 86% of pts felt affected by one or more symptoms to a slight to m oderate extent (mark 4 +/- 2.17). Palpitations were felt by 85% of the pts (mark 6 +/- 2.83), anxiety by 42% (mark 3 +/- 2.5), headache by 5 0% (3 +/- 2.54), nausea by 20% (2 +/- 1.72), angina pectoris by 42% (3 +/- 2.5), dyspnea by 30% (2 +/- 2.42) and discomfort of left lateral recumbant position by 43% (mark 3 +/- 2.59). 43 pts underwent coronary angiography. The negative predictive value of DSE to identify pts wit hout a coronary artery stenosis extending a 50% diameter reduction was 85% for the 16 pts who reached their individual submaximal heart rate compared to 60% for those 27 pts who did not reach it. Unspecific sym ptoms led to test termination in these pts. The positive predictive va lues were comparable (89 and 94%). Conclusion: DSE causes physical and mental distress. If symptoms lead to test termination before age corr ected submaximal heart rate is reached, normal wall motion does not ex clude significant coronary artery disease.