Comparison of bicycle, heavy isometric, dipyridamole-atropine and dobutamine stress echocardiography for diagnosis of myocardial ischemia

Several stress echocardiography (SE) modalities have been introduced for di agnosing coronary artery disease (CAD). Exercise and dobutamine SE are cons idered to have better diagnostic accuracy than vasodilator or isometric SE, but there are no studies in a single group of patients comparing these 3 t ests with heavy 2-arm isometric SE. The purpose of this study was to determ ine the diagnostic characteristics of 4 SE methods in patients with chest p ain. Altogether, 60 patients (age a SD 55.1 +/- 2.1 years) were tested with bicycle, heavy 5-arm isometric, dipyridamole-atropine and dobutamine SE. C AD (>50% stenosis) was present in 44 patients; 26 patients had 1-vessel dis ease. During bicycle SE, the double product at peak stress was higher than during dobutamine and dipyridamole-atropine SE (26.5 x 10(3), p <0.005 vs d obutamine and dipyridamole-atropine SE), and peak wall motion score index ( 1.40) was higher than during dipyridamole-atropine and isometric SE (1.26 a nd 1.07, respectively, p <0.05 vs bicycle SE). Bicycle, dipyridamole-atropi ne, and dobutamine SE had higher sensitivity than isometric SE (90%, 93%, 9 5%, and 30%, respectively, p <0.05 isometric SE vs others). There were no s tatistically significant differences with regard to specificity. Similarly, bicycle, dipyridamoleatropine, and dobutamine SE had a higher diagnostic a ccuracy than isometric SE (78%, 88%, 87% and 47%, respectively, p <0.05 iso metric SE vs others). We conclude that bicycle, dipyridamole-atropine, and dobutamine SE have an equal diagnostic accuracy in detecting CAD despite hi gher double product and ischemic burden at peak stress during bicycle and d obutamine SE over dipyridamole-atropine SE. Heavy isometric SE is inaccurat e. (C) 1999 by Excerpta Medico, Inc.