DIAGNOSTIC-VALUE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN CORONARY-ARTERY DISEASE

In order to assess the value of dobutamine stress echocardiography (DS E) for detecting coronary artery disease (CAD), 67 consecutive patient s (mean age +/- SD was 58 +/- 8 years, range 35 to 75; 46 men and 21 w omen) with known or suspected CAD undergoing selective coronary angiog raphy within the week following the DSE were studied. Two patients wer e excluded from the study because of insufficient echocardiographic im aging. Dobutamine (5 to 30 mug/kg/min by 5 mug/kg/min increments) was infused in 5-minute intervals. All the patients had 12-lead electrocar diogram (ECG) recorded at rest and at each stage of dobutamine infusio n. There was significant CAD (greater-than-or-equal-to 50% diameter st enosis) in 42 patients (64.6%), with 16 patients having 1-vessel, 7 pa tients having 2-vessel and 19 patients having 3-vessel CAD. In 22 pati ents coronary angiogram was normal. DSE was positive in 33 of 42 patie nts with CAD. The test was negative in 20 of 23 patients without CAD. Compared with coronary angiography, the overall sensitivity of DSE for detecting CAD was 78.6%, specificity 87%, positive predictive value 9 1.7%, negative predictive value 69%, and accuracy 81.5%. The sensitivi ty in those with one-vessel, two-vessel, three-vessel and multivessel disease was 62.5%, 85.7%, 94.7%, and 92.3% respectively. DSE was well tolerated in all patients. The study was not prematurely terminated du e to a side effect in any patient. This study indicated that DSE is a practical method for the non-invasive assessment of significant CAD, f or determining the patients who require invasive tests, and for predic ting the extent of disease. It is concluded that DSE is a safe, versat ile, totally non-invasive, and clinically useful test.