Value of dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch blockage

Background Left bundle branch blockage (LBBB) is a strong predictor of card iovascular mortality. Non-invasive tests such as exercise-stress testing an d scintigraphy studies have no diagnostic value for diagnosis of coronary a rtery disease (CAD) in patients with LBBB. Objective To study the role of dobutamine stress echocardiography (DSE) in identification of CAD in patients with LBBB. Methods Thirty patients (19 men and 11 women, mean age 60 +/- 8 years) with permanent, complete LBBB were studied prospectively with DSE and coronary angiography. Results Results of DSE were compared with results of coronary angiography f or left anterior descending artery and either left circumflex or right coro nary artery territories, or both. Significant CAD was found in left anterio r descending coronary arteries in 11 patients by coronary angiography; nine of whom were identified by DSE. Significant left circumflex or right coron ary artery disease, or both, was found in nine patients; eight of whom were identified by DSE. The sensitivity, specificity and accuracy of DSE for id entifying CAD in left anterior descending coronary artery territory were 82 , 95 and 90%, respectively. For identifying CAD in the circumflex and right coronary artery territories sensitivity, specificity and accuracy were 88, 96 and 93%, respectively. Conclusion We concluded that DSE is a very sensitive, specific and accurate non-invasive test for identification of CAD, both in left anterior descend ing and in left circumflex and right coronary artery territories of patient s with LBBB. Coron Artery Dis 11:545-548 (C) 2000 Lippincott Williams & Wil kins.