Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

Objective: The aim of the study was to compare the efficacy and safety of t wo stress echocardiography methods, exercise and dobutamine, in the diagnos is of coronary artery disease in hypertensive patients with angina. Patients and methods: A total of 197 treated hypertensive patients, age 53 +/- 9 years (65 women) with no history of myocardial infarction referred fo r coronary angiography were prospectively investigated with exercise electr ocardiography (ECG), exercise and dobutamine echocardiography. Results: Sensitivity of the exercise ECG, exercise echocardiography and dob utamine echocardiography did not differ (77%, 82% and 75%). Negative predic tive value of exercise ECG was significantly lower than exercise echocardio graphy (64% vs 79%, P < 0.01). Specificity and positive predictive value of exercise ECG were markedly lower than exercise and dobutamine echocardiogr aphy (57%, 96%, 98% and 72%, 97%, 98%, P < 0.0001 for both stress echocardi ography vs ECG). Specificity and sensitivity of diagnostic methods were not influenced by the presence of echocardiographic left ventricular hypertrop hy. Dobutamine infusion in comparison to exercise was more often associated with substantial arterial blood pressure rise or fall (7% vs 2%, P < 0.05) and with simple ventricular ectopy (15,7% vs 6,1%, P < 0.05). Conclusions: In hypertensive patients with the symptoms of angina, both str ess echo methods are significantly more specific than the exercise ECG test . Maximal exercise is associated with less frequent side effects than infus ion of dobutamine, so exercise echocardiography may be preferred in the dia gnosis of angina in hypertensive patients.