DOBUTAMINE 2-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STRESS-TESTING FOR DETECTION OF CORONARY-ARTERY DISEASE

Atrial pacing and dipyridamole transesophageal echocardiography have b een shown to be sensitive and specific tests for the detection of coro nary artery disease. However, the sensitivity and specificity of dobut amine transesophageal echocardiography have not been reported. The pur pose of this study was to determine the feasibility, sensitivity, and specificity of dobutamine transesophageal echocardiography fdr the det ection of coronary artery disease. Transesophageal echocardiographic a ssessment of left ventricular function was performed in 81 adult patie nts aged 62 +/- 12 years during stepwise infusion of dobutamine from 5 .0 to 40 mu g/kg/min. Ischemia was diagnosed by the development of sev ere hypokinesis, akinesis, or dyskinesis of a previously contractile l eft ventricular segment. Coronary artery disease was defined by angiog raphy as a reduction in luminal diameter of greater than or equal to 7 0% of an epicardial or greater than or equal to 50% of the left main c oronary artery. In patients who had undergone coronary artery bypass g raft surgery, a stenotic bypass graft was defined as a reduction in lu minal diameter of greater than or equal to 70%. In patients without pr evious CABG, significant coronary artery disease was present in 21 pat ients: 5 with single-vessel disease, 7 double-vessel disease, 8 triple -vessel disease, and 1 left main coronary disease. Dobutamine transeso phageal echocardiography had a sensitivity of 90% (19 of 21) and speci ficity of 94% (49 of 52) for the detection of coronary artery disease. In patients with previous CABG (n = 8), the sensitivity and specifici ty for the detection of bypass graft stenosis were 100% (4 of 4) and 7 5% (3 of 4), respectively. Dobutamine transesophageal echocardiography was safe and devoid of serious complications. Dobutamine transesophag eal echocardiography is feasible, safe, sensitive, and specific for th e detection of coronary artery disease and shows promise for the detec tion of bypass graft stenosis. Dobutamine transesophageal echocardiogr aphy may play a role in select patients for whom transthoracic echocar diographic studies are technically inadequate.