Dobutamine stress echocardiography for assessment of intracoronary stent implantation

Stress echocardiography has been shown to be a valuable noninvasive method for the diagnosis of restenosis after coronary angioplasty. To determine th e usefulness of dobutamine stress echocardiography (DSE) for assessment of restenosis after intracoronary stent implantation, we studied 50 patients ( 59 +/- 10 years; 1-vessel disease, n = 16; multivessel disease, n = 34) aft er stent implantation. After 6 months, both DSE (5-40 mcg/kg/min, 0-1 mg at ropine) and angiography were performed within 48 hours and evaluated in a b linded fashion. Restenosis was defined by quantitative coronary angiography as minimal lumen diameter (LD) < 50 % of average reference LD. Diagnostic criteria of DSE were new or worsening wall motion abnormalities in correspo nding perfusion territories during stress. Angiography revealed restenosis in 8 patients; one patient had a de-novo-stenosis distal to the stented seg ment (8x left anterior descending artery, 1 ACVB to the right coronary arte ry). In 6 of these 9 patients, DSE was positive (mean reduction of LD 88 +/ - 7 %; sensitivity 67 %), in 3 patients negative (mean reduction of LD 62 /- 7 %, 1 x termination of DSE because of wall motion abnormalities in an a rea not supplied by the stented vessel). In 38 of 41 patients without reste nosis, DSE showed no stress-induced wall motion abnormalities in the LV are a supplied by the stented vessel (specificity 93 %). Conclusions: DSE is a useful noninvasive method for detecting restenosis af ter intracoronary stent implantation. With negative DSE at follow-up, a fun ctionally relevant stent restenosis is highly inlikely.