ASSESSMENT OF THE CORONARY-ARTERY DISEASE AND SYSTOLIC DYSFUNCTION INHYPERTENSIVE PATIENTS WITH THE DOBUTAMINE-ATROPINE STRESS ECHOCARDIOGRAPHY - EFFECT OF THE LEFT-VENTRICULAR HYPERTROPHY

This study was performed to evaluate whether left ventricular hypertro phy (LVH) can influence the diagnostic accuracy of coronary artery dis ease (CAD) using the dobutamine stress echocardiography (DSE) in hyper tensive patients. In addition to the detection of CAD, the relationshi p between systolic dysfunction and the quantitation wall motion scorin g system of DSE was studied also, DSE was performed in 101 patients, T here were 45 (45%) patients with a history of acute myocardial infarct ion. Twenty-eight patients (28%) had electrocardiographic LVH and 59 p atients (58%) had echocardiographic LVH, A total of 74 patients (73%) had angiographically documented CAD defined as greater than or equal t o 50% diameter stenosis, For the 56 patients without history of myocar dial infarction, the diagnostic sensitivity, specificity, and accuracy in detecting CAI) were not influenced by LVH defined by either electr ocardiography or echocardiography, For the total patients, the diagnos tic sensitivity, specificity, and accuracy in detecting multivessel di sease were also not influenced by LVH defined by either method, The re sting global wall motion score was cor;elated well with the left ventr icular ejection fraction in patients with and without LVH (r = -0.70, p < 0.001 vs, r = -0.70, p < 0.001). When using the resting wall motio n score of 24 as a cutoff value, the diagnostic sensitivity, specifici ty, and accuracy of systolic dysfunction (defined by left ventricular ejection fraction <40%) were 79, 86 and 85%, respectively, In conclusi on, the diagnostic accuracy of CAD using the DSE was not affected by L VH in hypertensive patients, In addition to detection of coronary arte ry disease, the resting wall motion score of DSE was able to detect sy stolic dysfunction in patients with and without LVH.