Circulation, Vol 90, 1168-1176, Copyright © 1994 by American Heart Association
BD Beleslin, M Ostojic, J Stepanovic, A Djordjevic-Dikic, S Stojkovic, M Nedeljkovic, G Stankovic, Z Petrasinovic, L Gojkovic and Z Vasiljevic- Pokrajcic
BACKGROUND: Exercise and pharmacological stress echocardiography have
emerged as convenient alternatives to myocardial scintigraphy. The
objective of this study was to compare in the same patients the diagnostic
values of exercise, dobutamine, and dipyridamole stress echocardiography
tests for detection of myocardial ischemia. METHODS AND RESULTS: We
performed exercise (maximal treadmill Bruce protocol), dobutamine (up to 40
micrograms/kg per minute) and dipyridamole (up to 0.84 mg/kg over 10
minutes) stress echocardiography tests, in random sequence and on separate
days, in 136 consecutive patients. All patients underwent coronary
angiography. Significant coronary artery disease was defined by
quantitative coronary angiography as a lesion with a diameter stenosis >
or = 50%. A stress echocardiogram was considered positive when new or
worsening of preexisting wall motion abnormality was observed. Most of the
patients (94%) were receiving the same antianginal medication for each
stress test; 59 patients were receiving concomitant beta-blocker therapy.
The prevalence of coronary artery disease was 87.5%, with 108 patients
having one-vessel coronary artery disease. Peak heart rate and systolic
blood pressure were higher with exercise than with dobutamine or
dipyridamole (P < .01). Sensitivity of exercise, dobutamine, and
dipyridamole stress echocardiography was 88%, 82%, and 74% (dipyridamole
versus exercise, P < .01), respectively. Specificity was 82%, 77%, and
94%, respectively. The overall accuracy was 87%, 82%, and 77% (dipyridamole
versus exercise, P < .01), respectively. The accuracy of dipyridamole
was higher (P = .02) in the group of patients not receiving beta-blockers
(84%) than in the patients receiving beta-blocker therapy (66%), whereas
the accuracy of exercise and dobutamine were only slightly higher in the
patients not receiving beta-blockers. Significant side effects occurred in
3%, 11%, and 1% of patients during exercise, dobutamine, and dipyridamole
tests, respectively. CONCLUSIONS: Despite the different hemodynamic
effects, exercise, dobutamine, and dipyridamole echocardiography have high
overall diagnostic values. In this group of patients with a predominance of
one-vessel coronary artery disease, the overall diagnostic accuracy of
stress echocardiography tests was higher for exercise than for dobutamine
or dipyridamole. Concomitant beta-blocker therapy significantly decreased
the accuracy of the dipyridamole stress echocardiography test.
Pharmacological stress testing (dipyridamole without beta-blockers) can
therefore be used as an efficient option for detection of myocardial
ischemia in patients who are unable or poorly motivated to exercise
adequately.
ARTICLES
Stress echocardiography in the detection of myocardial ischemia. Head- to-head comparison of exercise, dobutamine, and dipyridamole tests
Department of Diagnostic and Catheterization Laboratories, University Clinical Center, Belgrade, Serbia.
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