ECHOCARDIOGRAPHIC DETECTION OF THE EXTENT OF CORONARY-ARTERY DISEASE IN THE ELDERLY USING DOBUTAMINE AND ADENOSINE INFUSION

Background The high prevalence of asymptomatic multivessel disease in the elderly and the fact that most of them can not carry out an exerci se stress testing renders the application of other stress modalities n ecessary. The aim of this study is to compare the diagnostic value of dobutamine and adenosine stress echocardiography and their accuracy in determining the extent of coronary artery disease in elderly people. Methods Dobutamine and adenosine stress echocardiography were performe d in 128 consecutive patients greater than or equal to 70 years-of-age with known or suspected coronary artery disease. All patients underwe nt coronary angiography within 2 weeks of the stress tests. Results Th e presence of any echocardiographic abnormality on dobutamine (odds ra tio 30.8) and adenosine (odds ratio 18.1) test, the need for cessation of dobutamine test and the ST depression during dobutamine infusion, were independent predictors of significant coronary artery disease. Bo th tests proved more sensitive for detecting multivessel disease (89% for dobutamine, 74% for adenosine test), than one-vessel disease (74 a nd 39%, respectively). This difference was statistically significant o nly for the adenosine echocardiography test (P = 0.008). In patients w ith localized resting wall motion abnormalities, the accuracy of dobut amine test to predict a remotely diseased vessel (70%), was statistica lly superior to the accuracy of adenosine test (57%, P = 0.008). Patie nts with multivessel disease showed delayed resolution of test-induced wall motion abnormalities, during the recovery period after both test s, compared with those who suffered from one-vessel disease. Conclusio ns Dobutamine echocardiography was more sensitive and accurate than ad enosine echocardiography in detecting and determining the extent and t he severity of coronary artery disease in the elderly. A positive aden osine echocardiography result reflected the presence of advanced coron ary artery disease. The two tests, combined with clinical data, could classify the elderly into low- and high-risk subgroups for ischemic he art disease. (C) Rapid Science Publishers. ISSN 0954-6928.