(Circulation. 2000;101:258.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Dobutamine-Atropine Stress Echocardiography for the Detection of Coronary Artery Disease in Patients With Left Ventricular Hypertrophy
Importance of Chamber Size and Systolic Wall Stress
From the Division of Cardiology, Medical College of Wisconsin, Milwaukee.
Correspondence to Kiran B. Sagar, MD, Medical College of Wisconsin, Division of Cardiovascular Medicine, 9200 W Wisconsin Ave, Milwaukee, WI 53226.
Background—Left ventricular hypertrophy is a heterogeneous disorder with distinct morphologies. Changes in wall thickness, left ventricular chamber diameter, and mass alter systolic wall stress of the left ventricle and may influence ischemic threshold. Thus, the goal of this study was to investigate the effect of the different patterns of left ventricular hypertrophy on the accuracy of dobutamine-atropine stress echocardiography.
Methods and Results—Three-hundred eighty-six patients underwent multistage dobutamine-atropine stress echocardiography and diagnostic angiography. Echocardiograms were measured for mean and relative wall thicknesses, chamber size, left ventricular mass, and end-systolic wall stress. The patterns of ventricular hypertrophy were concentric hypertrophy (increased wall thickness and mass), eccentric hypertrophy (normal wall thickness and increased mass), and concentric remodeling (increased wall thickness and normal mass). The overall sensitivity, specificity, and accuracy of dobutamine-atropine stress echocardiography for the detection of coronary artery disease were 85%, 87%, and 86%, respectively. Increased left ventricular mass index alone did not affect accuracy. Sensitivity was markedly reduced (36%) only in those with concentric remodeling. The univariate predictors of false-negative studies were single-vessel left circumflex disease, increased wall thickness, small chamber size, hyperdynamic ejection fraction, and left ventricular concentric remodeling. Multivariate predictors were concentric remodeling (P<0.0001; odds ratio, 13.5), left ventricular ejection fraction >2 SD above normal (P<0.0001), and single-vessel left circumflex disease (P<0.0007; odds ratio, 7.6). Sensitivity was excellent in patients with small ventricles and normal wall thickness and in those with normal or large chambers regardless of wall thickness.
Conclusions—Dobutamine-atropine stress echocardiography is an accurate test in most patients with left ventricular hypertrophy, but it is insensitive in the small subset with concentric remodeling.
Key Words: hypertrophy • echocardiography • coronary disease
This article has been cited by other articles:
 |
|
 |
|
  H. V. Dinh, J. Alvergue, J. Sayre, J. S. Child, V. S. Deshpande, G. Laub, and J. P. Finn Isovolumic Cardiac Contraction on High-Temporal-Resolution Cine MR Images: Study in Heart Failure Patients and Healthy Volunteers Radiology, August 1, 2008; 248(2): 458 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Senior, M Monaghan, H Becher, J Mayet, and P Nihoyannopoulos Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography Heart, April 1, 2005; 91(4): 427 - 436. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Satwani, G. W. Dec, and J. Narula {beta}-Adrenergic Blockers in Heart Failure: Review of Mechanisms of Action and Clinical Outcomes Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 2004; 9(4): 243 - 255. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Yalcin, H. Muderrisoglu, M. E. Korkmaz, B. Ozin, M. Baltali, and F. Yigit The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy Angiology, May 1, 2004; 55(3): 295 - 301. [Abstract] [PDF]
|
|
|
|
 |
|
 A. E. Weyman The year in echocardiography J. Am. Coll. Cardiol., January 7, 2004; 43(1): 140 - 148. [Full Text] [PDF]
|
|
|
|
|
|
W. Mathias Jr, J. M. Tsutsui, J. L. Andrade, I. Kowatsch, P. A. Lemos, S. M. B. Leal, B. K. Khandheria, and J. F. Ramires Value of rapid beta-blocker injectionat peak dobutamine-atropine stressechocardiography for detection of coronary artery disease J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1583 - 1589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Elhendy, K. M. Modesto, D. W. Mahoney, B. K. Khandheria, J. B. Seward, and P. A. Pellikka Prediction of mortality in patients with left ventricular hypertrophy by clinical, exercise stress, and echocardiographic data J. Am. Coll. Cardiol., January 1, 2003; 41(1): 129 - 135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Yuda, V. Khoury, and T. H. Marwick Influence of wall stress and left ventricular geometry on the accuracy of dobutamine stress echocardiography J. Am. Coll. Cardiol., October 2, 2002; 40(7): 1311 - 1319. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Bello, C. Caramelo, N. Martell, J. M. Alcazar, J. Gonzalez, M. D. Lopez, L. M. Ruilope, F. R. Gonzalez, A. M. Rovira, R. Gazapo, et al. Impairment of Renal Vasodilation With L-Arginine Is Related to More Severe Disease in Untreated Hypertensive Patients Hypertension, October 1, 2001; 38(4): 907 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Tadamura, H. Iida, K. Matsumoto, M. Mamede, S. Kubo, H. Toyoda, T. Shiozaki, T. Mukai, Y. Magata, and J. Konishi Comparison of myocardial blood flow during dobutamine-atropine infusion with that after dipyridamole administration in normal men J. Am. Coll. Cardiol., January 1, 2001; 37(1): 130 - 136. [Abstract] [Full Text] [PDF]
|
|