USEFULNESS OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR THE PROSPECTIVE IDENTIFICATION OF THE PHYSIOLOGICAL SIGNIFICANCE OF CORONARY NARROWINGS OF MODERATE SEVERITY IN PATIENTS UNDERGOING EVALUATION FOR PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Dobutamine stress echocardiography (DSE) was performed after coronary angiography to evaluate the need to perform percutaneous transluminal coronary angioplasty (PTCA) for 46 stenoses of moderate severity (50% to 80%) in 46 patients, Patients were divided into 2 groups according to the DSE results in the distribution of the coronary artery with the lesion of moderate severity: group I (n = 32) were those without indu cible myocardial ischemia; PTCA was not performed, Group II (n = 14) w ere those who exhibited myocardial ischemia; PTCA was performed in 12. The 2 groups were comparable in terms of clinical characteristics. Fo llow-up DSE was performed less than or equal to 48 hours after PTCA, a t 3 months, and 6 to 12 months after the first DSE. In group I at 3 mo nths, DSE results were still negative in the distribution of the vesse l with the moderately severe lesion in 24 patients; only 1 patient had a positive result, and 8 patients who refused DSE remained clinically stable, At 6 to 12 months (mean 7 +/- 2), 26 patients had negative st udy results; 3 patients who refused follow-up DSE remained clinically stable. In group II, 12 of 14 patients with inducible ischemia on the initial DSE underwent PTCA, Early follow-up DSE (less than or equal to 48 hours) was negative in 7, and 4 had persistent inducible wall moti on abnormalities in the myocardium subtended by the coronary artery in which the PTCA had been performed; 1 study was not performed. At 3-mo nth follow-vp, 1 patient who had an early DSE study positive for ische mia had no demonstrable ischemia, and 3 patients continued to have myo cardial ischemia in the myocardium subtended by the coronary artery in which the PTCA was performed. At the 6; to 12-month follow-up (mean 7 +/- 1), 8 patients had DSE studies that remained negative for inducib le ischemia, Thus, DSE is an appropriate test to assess the physiologi c significance of coronary artery lesions of moderate severity ii 1 pa tients being evaluated for PTCA.