PREOPERATIVE ASSESSMENT OF CORONARY-ARTERY DISEASE IN AORTIC-STENOSIS- A DIPYRIDAMOLE ECHOCARDIOGRAPHIC STUDY

Background. The aim of this study was to establish the feasibility, sa fety, and diagnostic accuracy of the dipyridamole echocardiography tes t in patients with severe aortic valve stenosis for noninvasive detect ion of coexisting coronary artery disease. Methods. The high-dose dipy ridamole echocardiography test was performed in 52 patients with sever e aortic stenosis; all patients also underwent coronary angiography, i ndependent of test results, before cardiac operation. Results. The dip yridamole echocardiography test was completed without major complicati ons. One patient had transient atrial fibrillation that was reversed b y aminophylline. Thirty-one patients (60%) had a negative test result; all had normal coronary arteries. Ten of the 21 patients (48%) with a positive test result had coexisting coronary artery disease. The posi tive predictive value of the dipyridamole echocardiography test for de tection of coronary disease in patients with severe aortic stenosis wa s 48%. The negative predictive value was 100%. The sensitivity was 100 % and the specificity was 74%. Conclusions. Dipyridamole echocardiogra phy is a safe and feasible tool in patients with severe aortic stenosi s eligible for a cardiac operation. A negative test result reliably ru les out a significant stenosis, whereas a positive one is much less ac curate in predicting coronary artery disease.