Circulation, Vol 83, 1605-1614, Copyright © 1991 by American Heart Association
SG Sawada, DS Segar, T Ryan, SE Brown, AM Dohan, R Williams, NS Fineberg, WF Armstrong and H Feigenbaum
BACKGROUND. Two-dimensional echocardiography performed during dobutamine
infusion has been proposed as a potentially useful method for detecting
coronary artery disease. However, the safety and diagnostic value of
dobutamine stress echocardiography has not been established. METHODS AND
RESULTS. In this study, echocardiograms were recorded during step-wise
infusion of dobutamine to a maximum dose of 30 micrograms/kg/min in 103
patients who also underwent quantitative coronary angiography. The
echocardiograms were digitally stored and displayed in a format that
allowed simultaneous analysis of rest and stress images. Development of a
new abnormality in regional function was used as an early end point for the
dobutamine infusion. No patient had a symptomatic arrhythmia or
complications from stress-induced ischemia. Significant coronary artery
disease (greater than or equal to 50% diameter stenosis) was present in 35
of 55 patients who had normal echocardiograms at rest. The sensitivity and
specificity of dobutamine- induced wall motion abnormalities for coronary
artery disease was 89% (31 of 35) and 85% (17 of 20), respectively. The
sensitivity was 81% (17 of 21) in those with one-vessel disease and 100%
(14 of 14) in those with multivessel or left main disease. Forty-one of 48
patients with abnormal echocardiograms at baseline had localized rest wall
motion abnormalities. Fifteen had coronary artery disease confined to
regions that had abnormal rest wall motion, and 26 had disease remote from
these regions. Thirteen of 15 patients (87%) without remote disease did not
develop remote stress-induced abnormalities, and 21 of 26 (81%) who had
remote disease developed corresponding abnormalities. CONCLUSIONS.
Echocardiography combined with dobutamine infusion is a safe and accurate
method for detecting coronary artery disease and for predicting the extent
of disease in those who have localized rest wall motion abnormalities.
ARTICLES
Echocardiographic detection of coronary artery disease during dobutamine infusion
Department of Medicine, Indiana University School of Medicine, Indianapolis.
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S. C. Smart, T. Knickelbine, T. R. Stoiber, M. Carlos, J. C. Wynsen, and K. B. Sagar Safety and Accuracy of Dobutamine-Atropine Stress Echocardiography for the Detection of Residual Stenosis of the Infarct-Related Artery and Multivessel Disease During the First Week After Acute Myocardial Infarction Circulation, March 18, 1997; 95(6): 1394 - 1401. [Abstract] [Full Text]
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M. E. Carlos, S. C. Smart, J. C. Wynsen, and K. B. Sagar Dobutamine Stress Echocardiography for Risk Stratification After Myocardial Infarction Circulation, March 18, 1997; 95(6): 1402 - 1410. [Abstract] [Full Text]
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M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]
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D. Pontillo, G. P. Carboni, A. Capezzuto, C. Alessi, A. Achilli, F. Piccini, and R. Guerra Identification of Viable Myocardium by Nitrate Echocardiography After Myocardial Infarction: Comparison with Planar Thallium Reinjection Scintigraphy Angiology, May 1, 1996; 47(5): 437 - 446. [Abstract] [PDF]
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S. Carstensen, S. M. Ali, F. V. Stensgaard-Hansen, J. Toft, S. Haunso, H. Kelbęk, and K. Saunamaki Dobutamine-Atropine Stress Echocardiography in Asymptomatic Healthy Individuals : The Relativity of Stress-Induced Hyperkinesia Circulation, December 15, 1995; 92(12): 3453 - 3463. [Abstract] [Full Text]
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J.-L. J. Vanoverschelde, B. L. Gerber, A.-M. D'Hondt, M. De Kock, R. Dion, W. Wijns, and J. A. Melin Preoperative Selection of Patients With Severely Impaired Left Ventricular Function for Coronary Revascularization : Role of Low-Dose Dobutamine Echocardiography and Exercise-Redistribution-Reinjection Thallium SPECT Circulation, November 1, 1995; 92(9): 37 - 44. [Abstract] [Full Text]
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C. Chen, L. Li, L. L. Chen, J. V. Prada, M. H. Chen, J. T. Fallon, A. E. Weyman, D. Waters, and L. Gillam Incremental Doses of Dobutamine Induce a Biphasic Response in Dysfunctional Left Ventricular Regions Subtending Coronary Stenoses Circulation, August 15, 1995; 92(4): 756 - 766. [Abstract] [Full Text]
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M. Arnese, J. H. Cornel, A. Salustri, A. P.W.M. Maat, A. Elhendy, A. E.M. Reijs, F. J. Ten Cate, D. Keane, A. H.M.M. Balk, J. R.T.C. Roelandt, et al. Prediction of Improvement of Regional Left Ventricular Function After Surgical Revascularization : A Comparison of Low-Dose Dobutamine Echocardiography With 201Tl Single-Photon Emission Computed Tomography Circulation, June 1, 1995; 91(11): 2748 - 2752. [Abstract] [Full Text]
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J. A. Panza, V. Dilsizian, J. M. Laurienzo, R. V. Curiel, and P. T. Katsiyiannis Relation Between Thallium Uptake and Contractile Response to Dobutamine : Implications Regarding Myocardial Viability in Patients With Chronic Coronary Artery Disease and Left Ventricular Dysfunction Circulation, February 15, 1995; 91(4): 990 - 998. [Abstract] [Full Text]
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D. Poldermans, P. M. Fioretti, E. Boersma, I. R. Thomson, J. H. Cornel, F. J. ten Cate, M. Arnese, H. v. Urk, and J. R. T. C. Roelandt Dobutamine-Atropine Stress Echocardiography in Elderly Patients Unable to Perform an Exercise Test: Hemodynamic Characteristics, Safety, and Prognostic Value Arch Intern Med, December 12, 1994; 154(23): 2681 - 2686. [Abstract] [PDF]
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E. C. Madu, W. Ahmar, J. Arthur, and T. D. Fraker Jr Clinical Utility of Digital Dobutamine Stress Echocardiography in the Noninvasive Evaluation of Coronary Artery Disease Arch Intern Med, May 23, 1994; 154(10): 1065 - 1072. [Abstract] [PDF]
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E. P. Steinberg Magnetic Resonance Coronary Angiography -- Assessing an Emerging Technology N. Engl. J. Med., March 25, 1993; 328(12): 879 - 880. [Full Text]
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H. Leong-Poi, S.-J. Rim, D. E. Le, N. G. Fisher, K. Wei, and S. Kaul Perfusion Versus Function: The Ischemic Cascade in Demand Ischemia: Implications of Single-Vessel Versus Multivessel Stenosis Circulation, February 26, 2002; 105(8): 987 - 992. [Abstract] [Full Text] [PDF]
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