Diagnostic value of dobutamine perfusion electrocardiogram in coronary artery disease

OBJECTIVES: Assess the sensitivity and specificity of electrocardiograms pe rformed during dopamine perfusion to detect coronary artery stenosis. PATIENTS AND METHODS: One hundred three coronary artery disease patients wi th a coronarography were studied; 23 coronarographies were normal, 59 patie nts were taking a beta blocker An exercise test was also performed in 54 ca ses. A dobutamine perfusion was given at increasing dosage up to 50 mu g/kg /min, in combination with intravenous atropine ii needed to obtain a heart rate close to the theoretical maximum. RESULTS: The ST segment could not be analyzed reliably in 12 patients. Ther e was an ST depression in 32 cases, an ST elevation in 20 and an isoelectri c ST in 39. The sensitivity of a positive test to detect stenosis was 67% a nd specificity was 83%. Test sensitivity increases with increasing number o f stenotic lesions. There were no false positives in patients with an ST el evation. Results were not related to gender nor beta blocker treatment. The exercise tests were globally comparable but poorer in patients taking beta blockers. There were no notable adverse effects. CONCLUSION: Dobutamine perfusion electrocardiogram is a simple well-tolerat ed exploration method for the diagnosis of coronary artery disease applicab le in all patients. Its diagnostic value is similar to that of the exercise test and better in patients taking beta blockers. Specificity is excellent and sensitivity is acceptable, particularly in patients with mulitvessel d isease. (C) 1999, Masson, Paris.