764-2 Comparison of Transesophageal and Transthoracic Dobutamine Stress Echocardiography for Identification of Multivessel Coronary Artery Disease

Abstract

We have previously demonstrated the utility of dobutamine stress echocardiography (DSE) using transesophageal imaging (TEE) in identifying wall motion abnormalities (WMA) secondary to flow limiting coronary stenoses. The purpose of this study was to determine whether TEE is more accurate than transthoracic echocardiography (TTE) in identifying multivessel coronary artery disease (MVD) by demonstrating new WMA in more than one vascular territory. Twenty eight male patients (pts) age 66 ± 10 had simultaneous TEE and TTE during DSE and then underwent coronary arteriography. Twelve pts had MVD (≥ 50% stenosis in ≥ 2 vessels by quantitative coronary arteriography) with a total of 32 diseased vascular territories. TEE correctly identified all 12 MVD pts as having at least 1 flow limiting stenosis vs 10/12 by TTE. TEE correctly classified 11/12 pts as having MVD vs 5/12 by TTE (p < 0.03). TEE identified new WMA in 31/32 diseased vascular territories vs 19/32 by TTE (p < 0.001). TEE correctly classified all 8 pts with 3 vessel disease (3VD) vs 4/8 byTTE (p < 0.03). In addition TTE failed to identify any new WMA in 2 pts with 3VD. TEE was more accurate than TTE in identifying left anterior descending (LAD) and right coronary artery (RCA) disease (p < 0.03 and p < 0.01). while accuracy for identifying left circumflex disease was similar (p = 0.50). These data suggest that DSE using TEE is more accurate than TTE in identifying the presence and extent of MVD, particularly in pts with 3VD. Hence DSE using TEE appears to be an excellent method for risk stratification of pts with coronary artery disease.